...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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...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 weaknesses. Many people fear the process of aging. They become unable to continue the same lifestyle that they once had and they often are more ill and have to be looked after by family or others. The same can be said about the psychologically vulnerable who quite often have to depend on someone else to live as functional a life as possible...
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...Care Management Model Based on My Philosophy Care Management A shift from encounter based care to continuums of care is one of the biggest changes occurring in health care today. This change is driven by governmental legislation, payer incentives, and the recognized need by providers and healthcare systems. The lack of coordinated care results in medical errors, unnecessary procedures, and other forms of waste. This also creates higher costs for the patient, lower quality, and produces an unsatisfactory patient experience. A study performed by the Midwest Business Group on Health in collaboration with the Juran Institute revealed that 30% of all health care expenses result from poor quality care. In 2009, total health expenditures in the U.S. were $2.5 trillion. This means that $750 billion was the result of poor quality (Ralston & Park, 2011). Care Management Model Based on My Philosophy Case management and clinical pathways are strategies used to manage patient care. Although they use different approaches, both are related. The primary function of a case management program is to enhance the coordination of needed resources for patients and their families. Case managers facilitate access to services, both clinical and non-clinical, by connecting the individuals to resources that support him/her in playing an active role in the self-direction of his/her health care needs. Clinical pathways, on the other hand, are tools and systems. The tool reflects only part of the case...
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...EVALUATION Current Business Research Project Reporting Characteristics of Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals by Senthil P. Kumar used descriptive methods of research to discover the number of research journals of the pain experienced in cancer patients toward the end of life. The research delved into the end-of-life care journals published from 19 facilities from 2009 – 2010 (Kumar, 2011). The study involved finding the percentage of research journals for end-of- life cancer patients’ pain in comparison to actual number of research findings. The data collection methods involved a search of Journals that had terms such as hospice, end-of-life, supportive, and palliative in the titles (Kumar, 2011). A total of 19 journals included in the study, which had a total of 2600 articles researched in the study. The studies uncovered articles concerning cancer pain, of which most were categorized into ‘original articles’ and ‘review articles’. Original articles were separated to studies of quality and also of quantity. Quantitative studies were grouped according to the study designs. Once the findings of the number of articles study designs were computed, the total number of journals pertaining to end-of-life pain of cancer patients was determined. Later categorization of articles were sort into groups such as those related mostly to cancer pain, articles with studies related to pain...
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...Enhancing end-of-life care (EoLC) is a core component of international governments’ health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse’s role. Originating in the UK, EoLC pathways have been adopted around the world.Their broad aim is to optimise the quality of the dying process, enabling people to ‘die well’ across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory. Key words: End-of-life care l Care pathways l Terminal care l Health promotion Michael Allen is Staff Nurse, Chemotherapy Day Unit, Singleton Hospital, Abertawe Bro- Morgannwg University Hospital Board, Swansea, Wales; Tessa Watts is Senior Lecturer, Swansea University,...
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...Care Plan Elements of Hypertension Susan Salby American Sentinel University Care Plan Elements of Hypertension Worldwide, hypertension is the most common contributor to death of any medical risk factor. HTN contributes to the development of heart disease, heart failure, chronic renal failure requiring dialysis, stroke, peripheral vascular disease and cognitive decline. The risk of cardiovascular events doubles for every 20/10mmHg rise in blood pressure above 115/70mmHg. Untreated HTN causes progressive renal and vascular damage, eventually leading to a treatment resistant state. Hypertension is usually diagnosed and treated in the community. As this is largely an asymptomatic disease, particularly in its initial stages, compliance with treatment regimens can be problematic. Successful treatment of HTN relies on the patient establishing an ongoing therapeutic relationship with a trusted and knowledgeable health professional (Casey, 2011). Tools to manage care, such as clinical pathways, practice guidelines, and best practices have increased as the health care insurance industry has put more pressure on health care providers to improve care and provide more cost-effective care. These tools offer health care providers the opportunity to determine the best approaches to clinical problems based on current research and expertise (Finkleman, 2011). Best Practices Best practices are those treatments, procedures, tests, therapies and interventions that have consistently...
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...best in healthcare. The careful scientific evaluation of clinical practice became a prominent focus during the second half of the 20th century.1 More recently, attention has been paid to methods of determining which of multiple proven approaches to a healthcare problem works best for which patients.2 Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. It evolved from evidence-based medicine, which was developed in Canada to teach medical students. “Evidence-based medicine has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”3, p. 3 The National Quality Forum’s report A National Framework and Preferred Practices for Palliative and Hospice Care Quality is a consensus report that is a first step toward introducing evidence-based measures into palliative practice on a formal, national level.4 The Agency for Healthcare Research and Quality (AHRQ) supports organizations in their efforts to improve the quality and efficiency of healthcare by facilitating the use of evidence-based research findings in clinical practice.5 The nursing discipline has also embraced evidence-based practice over the past 25 years, initially through its support of “research utilization,” the integration of research into nursing curricula, and the education of nurse scientists. Sigma Theta Tau International, the Honor Society of Nursing,...
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...Clinical Oncology, 2014. Calene Roseman NUR / 544 Nursing Research Utilization Project August 18, 2014 Dr. Margarret Colucceillo 2 Nursing Research Utilization Project Proposal Clinical issue: The improvement of morbidity and improved recovery for patients with bladder cancer. Undergoing radical cystectomy with ileal conduit (Castle. & Pruthi,2013) The problem that I identified and needs a solution is the improvement of post-operative outcomes and morbidity for bladder cancer patients undergoing radical cystectomy with ileal conduit (Kim.Yu.Jung.Lee.& Lee.2013)With the aim to discharge patients using fast track and clinical pathways and improve quality of life and morbidity. Radical cystectomy is a serious and extensive surgery not without risk and complications, hence the fact that complications occurs frequently. (Kulkarni. 2011) the standard care for bladder cancer is cystectomy. (Kulkarni.2011) During this major surgery the bladder is removed along with seminal vesicles, the prostate and lymph nodes (Ohio State University, department of surgery,) The diversion or ileal conduit is shaped by removing a small part of the...
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...are three different pathways to become a registered nurse. The three pathways include; the baccalaureate degree program, associate degree program, and the diploma program. All of these pathways allow the student to take the NCLEX-RN and become a registered nurse. What is the difference between the programs and student outcomes if all the students end up with the same licensure? The difference is the technical nurse versus the professional nurse. This paper will focus on the difference in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level in nursing. "The existence of multiple pathways contributes to a confusing landscape of nursing education and creates challenges for aspiring nurses as they try to choose the most appropriate type of program in which to enter the profession" (book reference). The associate and baccalaureate programs are available to anyone who wishes to pursue a career in nursing, but the two programs prepare two different types of nurses. The associate degree level nurse is more focused on task oriented practice and are more technical driven and clinically competent. On the other hand, the baccalaureate degree level nurse is more professional and use evidence based practice and advanced critical thinking skills. Also, the baccalaureate degree level nurse is prepared to be in a leadership and management role versus the associate degree level nurse who is more geared towards bedside care. “Baccalaureate nursing...
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...Standards Pathway Practice Standards are based upon expert nurse input, nursing literature and research that supports the qualities of a positive practice environment. All 12 standards apply to health care organizations and long term care institutions. Additional standards apply to the long term care environment. 1. Nurses Control the Practice of Nursing A shared governance model centers a healthy work environment for nurses. RNs directly involved in decisions that affect nursing practice with demonstrated autonomy and responsibility experience higher job satisfaction and contribute to improved quality of care and safety for patients. 3, 10, 11, 15 2. The Work Environment is Safe and Healthy An environment where safety is paramount for both nurses and patients is essential to the delivery of quality nursing practice. Studies indicate that work environments with a culture of safety demonstrate a reduction in work-related injuries. 16, 25 A supportive work environment that encourages the health and well-being of staff is also essential. 3. Systems Are in Place to Address Patient Care & Practice Concerns Pathway-designated organizations provide dispute mechanisms to address patient care and practice concerns without retribution. Silence and poor communication lead to patient safety issues and reduced job satisfaction. 2, 20 In 2009, the Joint Commission recognized implemented a standard to address conflict-and-dispute resolution in health care.17 In A study...
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...different pathways to new experiences’ could be interpreted in many different ways. In The Story of Tom Brennan by JC Burke, Tom experiences different emotions and situations as he attempts to move into the world when his brother Daniel is involved in a tragic car accident. The image by Image Zoo also shows four different pathways leading into the one tree with branches that lead up into the sky. This picture shows the tree of life and how people can take different paths to experiences. I Measure Every Greif I Meet is a poem by Emily Dickinson that shows the strength a person needs to overcome grief in their lives. The strength comes within the individual and their surroundings. All three of these texts show that moving into the world involves different pathways to new experiences shown through different circumstances, problems and views. The image by Image Zoo reflects the idea that moving into the world involves different pathways. This image uses the rule of thirds and symbolism to bring attention to the four different pathways to the centre tree trunk. The rule of thirds draws central focus to the light coming from the tree. This light symbolises the light that is present through different pathways and journeys. Light symbolises the hope, possibilities that come with moving into the world. Even though each pathway comes to the same centre of light, it branches upwards into different pathways shown at the top of the tree trunk. The tree symbolises the “Tree of life” as the tree...
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...This document will address the following topics: developmental pathways to juvenile delinquency as it relates to parental influence, family history and family poverty. Additionally this document will address different approaches on preventing juveniles from these issues, especially as it applies to the relationship between minors and their parents and or legal guardian. According to Doggett (2001), something is going on in today’s society as it appears if more and more children are committing delinquent crimes. Based upon my readings, juveniles are committing repetitive crimes because of their family structure. When the juvenile is released from jail and they return home, if their family structure is the same when they left then the same...
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...000764715 Programme: BSc (Hons) Nursing (Adult Nursing) Course Title: Patient Pathways of Care in Adult Nursing 1 NURS 1442 Cohort: 9/13 PGT Leader: Debbie Dorsett Submission Date: 25th August 2015 Word Count: 3250 This essay will be exploring a patient pathway in a clinical environment. The pathway to be investigated is the national diabetes pathway from the National Institution for Health and Care Excellence (NICE), which was published in February 2015 (NICE, 2015). I will also exploring local agendas and guidelines that are available from a local trust. I will be exploring one patient in particular, who cannot be named for confidentiality reasons, in accordance with the Nursing and Midwifery Councils (NMC, 2008) the code of conduct governing patient confidentiality, (NMC, 2008). Diabetes is growing in the United Kingdom (UK) at an alarming rate, (Diabetes UK, 2012). In 2010, evidence showed that approximately 3.1 million people in the UK aged over 16 years old have diabetes. By 2030, this figure is estimated to rise to 4.6 million, (National Health Service [NHS], 2014). It is important as an adult nurse, that I understand the pathway of diabetes as individuals with the condition are at risk of developing further health complications (Diabetes UK, 2012). This includes conditions such as heart disease, stroke and blindness (Diabetes UK, 2012a). A pathway is a “foreseen care placed in an appropriate time frame, written and agreed by a multidisciplinary team...
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...home-acquired pneumonia. Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives. Soo Chan Carusone,1 Mark Loeb,1,2 and Lynne Lohfeld1,3 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada2Department of Pathology and Molecular Medicine, McMaster University, Canada 3Program for Educational Research and Development, McMaster University, Canada Corresponding author. Soo Chan Carusone: chansy@mcmaster.ca; Mark Loeb: loebm@mcmaster.ca; Lynne Lohfeld: lohfeld@mcmaster.ca Received September 19, 2005; Accepted January 23, 2006. Pneumonia is the inflammation of the lung parenchyma, build up fluid in the tissue of the lungs and then this infection spread in to whole body. The causes are mainly by Viruses, Bacteria, often caused by parasites or fungi. Pneumonia is the 5th leading cause of death in elderly. It may be unrecognized due to many factors such as it may be asymptomatic, or may be confused with other medical Pneumonia and other lower respiratory infections occur frequently among older adults residing in long-term care facilities. These infections are the most common reason for why residents are transferred to hospital. Such transfer is not only a frightening experience for these seniors, but may also be associated with multiple risks including decline in functional status, falls, delirium, and acquisition of multi-drug resistant bacteria. A clinical pathway or algorithm designed to manage...
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...Targeted Therapy: A New Generation of Health Care Innovation Michael A. Kline University of Phoenix HCA/210 Introduction to Health Care Jon Lasell February 9, 2014 Targeted Therapy: A New Generation of Health Care Innovation Could targeted therapy be the “new” trend in fighting degenerative cancer genes that are affect nearly 13,000,000 people in the world? Scientific and technological advances and in the health care system have, and will continue to change as long as there are researchers willing and able to create new innovations for the continuum of care. There is no general definition for molecular or targeted therapy. Targeted therapy can block the growth and spread of cancer, thus preventing cancer cells from dividing or destroying. The idea behind this therapy is to create drugs that attack molecular pathways that cause disease, without upsetting the normal functions of other cells and tissues throughout the human body. The American Cancer Society list Breast cancer as the second cause of death in women, right behind brain and other nervous system cancers. Over, 2,000,000 women have been diagnosed with HER2 positive breast cancer, and this number will continue to rise and fall. Targeted therapy has already had a significant improvement for the outcomes for patients with HER2 positive breast cancer. However, Chemotherapy continues to be the mainstream way for cancer treatments because of evaluations on safety and ability from the drug combinations of...
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