Critical Analysis of Patient Care Utilising John’s Model...

Introduction The aim of this assignment is to reflect on the management of a patient with multiple organ dysfunction syndrome (MODS). Reflective practice is associated with learning from experience, (Johns Freshwater 1998) and viewed as an important strategy for health professionals who embrace life long learning (Department of Health 2000). Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice (Benner 1984; Johns Freshwater 1998). Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through direct experience. It is this that enables the practitioner to†¦show more content†¦Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous. Mr Cox’s sedation was stopped (Midazolam and Morphine) following the insertion of a tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many attempts he was difficult to wean from the ventilator and eventually there was reduced base entry. Mr Cox’s abdomen became increasingly distended and his jejunostomy feed was stopped and TPN was commenced. Due to an increase in sepsis he returned to theatre for a laparostomy washout, it was discovered that his bowel loops were necrotic. An Endoscopy following a further GI bleed confirmed an arterial bleed, and it was deemed he was still unstable for any further surgical intervention. Mr Cox continued to deteriorate with sepsis and MODS, consequently at this point, it was decided to withhold and withdraw treatment. Renal replacement therapy (RRT) was withdrawn as he was still profoundly acidotic with no improvement, and surgical intervention withheld due to instability. All other treatment was continued, but he was ‘Not for resuscitation’ in the event of cardiopulmonary arrest. Mr Cox died after 30 days in ITU. Aesthetics Aesthetical knowing is defined by Johns as the intuitive nature of grasping, interpreting, envisioning and responding (Johns 1995). Nurses’ aesthetic qualities are sometimes referred to as the ‘art of nursing’Show MoreRelatedEssay on Mental Health Care Assessment1321 Words   |  6 PagesFor confidentiality (NMC, 2008) purposes, patients’ real names will not be used. Introduction Within this essay, I will reflect and critically analyse an OSCE which has increased my awareness, or challenged my understanding, in assessing the holistic needs of a service user (John), referred by his GP, whilst incorporating a care plan using the Care Programme Approach (CPA). By utilising this programme and other sources of current literature, I hope to demonstrate my knowledge and understandingRead MoreA Reflective Account of Valuing Diversity and One Aspect of Anti-Discriminatory Practice Which Relates to a Client from Clinical Placement.4442 Words   |  18 Pagesorganisation and its patients. The Nursing and Midwifery Council (2002) incorporates the idea of non-judgemental care into its code of professional conduct by maintaining clause 7 of the UKCC Guidelines for Professional Practice (1996, pp25) who instructed â€Å"as a registered nurse, midwife or health visitor you are personally accountable for your practice. In the exercise of your professional accountability you must recognise and respect the uniqueness and dignity of each patient and client and respond

The Relationship between Organizational Management and Unions

Management and Unions The relationship between unions and organization is a touchy one. Dating back to the start of unionization in the 19th century, the two bodies have held opposing viewpoints. Unionization was formed from the opinion that organizations took advantage of workers and some form of a negotiating agreement was needed. There were documented events of workers working long taxing hours for insignificant pay; no healthcare coverage; dangerous working conditions; and gender and or racial discrimination. Companies believed that unionization caused less productivity which endangered profits. Companies also believed that unions interfere in daily processes, and limits the employer’s say over compensation and benefits. The†¦show more content†¦Prior to the arrival of unions in the workplace, conditions were considered unsafe and workers continuously moaned about poor wages and benefits. Unions pursued to improve the working conditions for members through fair and reasonable wa ges, quality healthcare and benefits; and safe working conditions and quality of life. The union represented the workers and through a collective bargaining process negotiated the interests of the workers. Collective bargaining helps work through tribulations with the organization. Collective bargaining is the process between employers and employees to reach an agreement regarding the rights and responsibilities of employees. This tool used to come to a collective agreement which concentrates on different things such as employees working hours, their pay their rights, rules and details of how to participate in company affairs. (Lewin, 2012) Unions have had their share of developing troubles. The joining of two power house unions in 1955, American Federation of Labor (AFL) and Congress of Industrial Organization (CIO), reportedly had a collective membership of fifteen million. 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Role of Nurses in Gestational Diabetes Free Essays

The role of nurses in gestational diabetes. (DIABETES CARE)(Brief Article) Journal of Diabetes Nursing | May 1, 2003 | Assignment 2 Research studies, recently conducted in America, have found that diet and exercise play an important role in predisposing a woman for gestational diabetes (GD). This study compared the rate of insulin treatment and perinatal outcome in women with gestational diabetes under endocrinologist-based versus diabetes nurse-based metabolic management. We will write a custom essay sample on Role of Nurses in Gestational Diabetes or any similar topic only for you Order Now A total of 244 participants received endocrinologist-based care and 283 participants received diabetes nurse-based care. A retrospective analysis was carried out comparing maternal characteristics, rate of insulin treatment and perinatal insulin requirements, in comparison with those who had used diet and exercise as a controlling factor for their diabetes. Pregnancy imposes a great amount of stress on most bodily functions and it is certain that glucose metabolism is no exception. Gestational Diabetes Mellitus is a type of diabetes, which occurs during pregnancy, distinct from the condition that already existed. It is defined as a glucose intolerance of variable degrees with onset or first recognition during pregnancy; it will generally develop in the latter half of the pregnancy and will improve after delivery (Colman, 2004). Gestational Diabetes is generally not dangerous to either mother or fetus. The disease itself is usually mild and even asymptotic; however there is an increased incidence of foetal and perinatal complications (Guthrie amp; Guthrie, 2004). In addition, if an unreasonable amount of sugar is allowed to circulate in the mother’s blood and then to enter the fetal circulation, potential problems for both mother and baby are serious. The mother’s pancreas work’s overtime to produce insulin, but it is not enough to lower blood sugar levels. Glucose will then cross the placental barrier, increasing work on the pancreas of the fetus, which uses insulin to convert the glucose into energy. The baby has more energy than is required so it converts this energy into fat stores, resulting in large birth weight babies and all the problems that can be associated with that (http://diabetes. org). At each visit to the doctor a sample of urine is taken, this is then tested for glucose levels. Sugar in the urine may be the first indications of Gestational Diabetes. Also, during the fifth month a glucose tolerance test is now a routine test for pregnant women. A Glucose Tolerance Test is when the women provide a blood sample taken before and after consuming a glucose drink, glucose levels gt;9. 0mmol/l indicate Gestational Diabetes is present. However this may be performed earlier on someone who is considered as being at risk (Colman, 2004). The incidence of gestational Diabetes has increased a significant amount, between35% and 59%, over the past ten years (http://diabetes. rg). Studies have found that the figures have shown an alarming incline in the amount of women being diagnosed with this gestational Diabetes. It is now believed that between 2 and 12% of pregnant women suffer from Gestational Diabetes (Guthrie amp; Guthrie, 2002). Testing has now become routine for pregnant mothers, so it is being discovered earlier in the pregnancy and as a result is now being treated much sooner. Because of this routine testing the chance of miscarriage and perinatal loss has been greatly reduced. The survival rate of these infants has increased from less than 70% a few years ago to nearly 98% now, a figure which has only come about through care specializing in diabetes in pregnancy, routine testing of all pregnant women and the best care available (Guthrie amp; Guthrie, 2002). Even though gestational Diabetes is now being discovered more often and being medically controlled a woman who has had Gestational Diabetes will have a much higher chance of developing diabetes later in life. If insulin was required as treatment, there is a 50% chance of diabetes within 5years, and even if the diabetes was dietary controlled there is still a 60% chance of developing diabetes within 10-15 years (Australian Bureau of Statistics, 2007-08). With these alarming figures it is obvious that further understanding of the treatment and control of gestational diabetes is necessary. From the whole number of applicants, researchers then divide participants into stratified samples; containing those who were at risk for gestational Diabetes and those who had no known predisposing factors. Each of these strata was then further divided into halves, with one half continuing their usual daily activities and progress through the pregnancy with current medical assistance available. The other half of the group was required to stick to a strict regime of healthy diet and exercising at least once a week, more if they wish. There was an initial interview conducted between the 6-12 week period of pregnancy, during the first trimester, to ensure that the required information is collected and any information can be supplied and ensure that is understood. The interview incorporated data from the year prior to conception and continued until 2 months following the births of the children. All participants were required to test daily their Blood Glucose Level (BGL) and also test their urine for sugar and record their findings. While there would be an occasional increase in glucose levels during pregnancy, persistently high levels would indicate Gestational Diabetes and a Glucose Tolerance Test was conducted. Weekly follow ups were conducted to ensure all information was recorded accurately, and also permitted time for the participant to discuss any concerns that had arisen. However pregnancy requires a number of checkups, increasing towards the later trimester, so data was also collected through the ante natal clinics. After delivery another Glucose Tolerance Test was performed to evaluate for preexisting Diabetes and it also allowed time for any complications for the newborn to arise. For the purpose of this study I feel that a larger number would be required to make certain that there would be women who are at risk, have had gestational diabetes and have never suffered from this condition before, and would also allow for the inevitable elimination of some of the participants. This was a quantitative research process, there was a need to interview, assess and gather personal information on the study participants. Some participants may deem this an invasion of privacy. To ensure that no emotional or psychological damage occurs to the participants it would be extremely important to ensure that there would be the strictest confidentiality with the information provided and that it would only be shared with those who require the data. The aim of this research is to understand whether gestational Diabetes can be avoided all together, or whether it can be treated more effectively, providing a better health outcome for the fetus and mother. By providing conclusions, which benefit society, the principle of Beneficence can be achieved (Roberts and Taylor, 2002). An even more critical consideration is the health and well being of the participants. All women are naturally concerned that their baby will be healthy and normal; a researcher must be able to ensure that no harm will come to the mother or child. The principle of non-malfeasance, makes certain that no injury will occur to either mother or fetus, that the participants are not exploited in any way and that the benefit to the community outweighs any risk that may be present (Roberts and Taylor, 2002). At all times, the participants were treated with respect, confidentiality and their physical and mental welfare was maintained. The most important point to remember here is effective communication, the participants understood exactly what was being researched, and they received accurate information on when, where, how, why and who. They were given education sessions on how to use any of the equipment that had been supplied. The equipment used were Urine dipstick and BGL machine, requiring only a small amount of training to make sure they were used properly. As the researcher, it is important to be precise and clear about this information to ensure that participants show up, on time and at the right place. (Roberts and Taylor, 2002). By incorporating the interviews and research into their ante- natal care visits, which would normally take place; the researchers avoided any complications arising from data collection. Participants were required to provide accurate, detailed and correct information on their experiences for the research to be valid and have any true meanings. This requires a great amount of trust on the researcher behalf. By ensuring that the participants understood the importance of this study, for their own health as well as the wider community, it would be hoped that the participants would record precise information. For many people, being diagnosed with gestational diabetes can be upsetting. Treatment for gestational diabetes substantially reduces adverse perinatal outcomes and improves maternal quality of life. Optimal proven treatment for gestational diabetes includes review by a diabetes educator, dietitian and physician, with insulin used if glycaemic targets are not achieved with dietary control alone. Screening for gestational diabetes should be offered to all pregnant women. Maternity service providers should ensure that adequate resources are devoted to the detection and treatment of gestational diabetes. References Australian Bureau of Statistics. National Health Survey, 2007-08 http://www. abs. gov. au 10/04/10 Colman, M. 2004, Diabetes and you: An owner’s Manual, Diabetes Australia, Melbourne. Diabetes Australia. Diabetes and Pregnancy, http://diabetes. org/gestational-diabetes 05/04/10 Guthrie, D. A. amp; Guthrie, R. A. , 2004, Nursing Management of Diabetes Mellitus: Fifth Edition, Springer Publishing Company, New York. Roberts, K. L. amp; Taylor, B. J. , 2002, Nursing Research Processes: An Australian Perspective, 2nd Ed. , Nelson Thomas Learning, Southbank, VIC. The role of nurses in gestational diabetes. DIABETES CARE, Journal of Diabetes Nursing, May 1, 2003| How to cite Role of Nurses in Gestational Diabetes, Papers

Death Of A Salesman Symbolism Essay Example For Students

Death Of A Salesman: Symbolism Essay Many symbols are incorporated into the play Death of a Sales man andthey in turn relate to both character and theme. The hose, tape recorderand th e seeds are some of these symbols. The hose in Millers drama directly relates to the theme of d eath. The hose is a line attached to the gas main in Willys house which allowshim to snif f the gas. This action can be seen as Willys suicide wish, andescape from the realities of life. As seen in the loss of his job and hisfailure to succeed. The hose also represents grief and deception. For whenLinda, Willys wife, finds the hose, she is distraught over its in tendedpurpose. The deceptive nature of the hose is apparent when Willy isconfronted about it by Biff his son and Willy denies its existence. Asimilar denial is also evident when Willy is confronted with the taperecorder in Howards office. The tape recorder signifies the change in Willys life throug h theadvancement of technology. It also represents the end of Willys career. This is brought about when Howard, Willys boss and godson, shows the taperecorder to Willy and appe ars to be more interested in the sound andtechnology of the machine instead of Willy, who i s fighting for his job. Howard no longer need s Willys services and without concern fires him. This , to Willy, was like, eating the orange and throwing away the peel. However, Willy is partly to blame, as he does not accept change and wantsto remain in the pas t. This is foreshadowed in the scene where Willy isleft alone with the tape recorder and is unable to shut it off. Willybelieves in using his old techniques and style to succeed. N evertheless,in hi job, it is not what you know, but it is who you know. Willy is not upto date with the business nor technology. Yet, Willy still has hope, andwishes to leave some fo rm of support behind for his family as illustratedin his planting of the seeds. Willy feels that he must leave something behind something for Biff. InWillys imaginary world he wants Biff to be magnificent and he symbolically plants seeds in his garden. In spite of such an action he is doomed tofail. Willy sta rts planting the seeds at night, but at night there is nosun shining and this seems very od d as seeds require light to grow. Whatelse is strange is the fact that Willys house is boxed in between largeapartment buildings and is covered by the shadows cast by them. It iseviden t that no light will fall on Willys garden. Willys attempt toplant and grow seeds is futile, but he persist in his attempt to seekreconciliation and forgiveness. Thus the hose, tape record er and the seedsare all symbolic of Willys dreams gone sour, and his inability to live inthe present. His death is inevitable and is mirrored by his life.