Reading Research Literature # 1 Assignment Example | Topics and Well Written Essays - 500 words

Reading Research Literature # 1 - Assignment Example Journal of General Internal Medicine, 28(3), 436-443. doi:10.1007/s11606-012-2234-y http://search.ebscohost.com.proxy.chamberlain.edu:8080/login.aspx?direct=true&db=rzh&AN=2012018670&site=ehost-live The purpose of this research is to carry out an examination of hospital discharge processes such as patient education for patients with acute myocardial infarction and identify which discharge processes may be useful in performance in medical facilities for hospitals AMI care. The research used qualitative study of US hospitals based on RSMR reports by CMS. Hospitals used ranked in top and bottom 5 % in consecutive two years as reported by RSMR. The method used was deviant case sampling. Data was collected using interviews and ground theory approach through visits to the 14 sites to the hospitals. The focus of the study was on hospitals that ranked in the top 5% and bottom 5% of RSMR. The hospitals chosen could be able to perform percutaneous intervention. The hospitals sample used was based on socioeconomic status, geographical and RSMR status. The sample was adequate for the research design because results could be deduced form it. Results showed that there were distinct differences in discharge processes between high and low performers in hospitals. Such results were only finalized due to the sample used. Ancheta, I. B. (2006). A retrospective pilot study. Dimensions of Critical Care Nursing, 25(5), 228-233. http://search.ebscohost.com.proxy.chamberlain.edu:8080/login.aspx?direct=true&db=rzh&AN=2009297932&site=ehost-live A pilot study was conducted under authority from HIPPA. 300 clinics records of patients were used in the investigation of the study. Data collected was demographic such as age, ethnic background, and marital status. The focus of the study was on the patients records that met the criteria of diagnosis of chronic stable CHF secondary to decreased systolic left ventricular dysfunction EF of less

Service User And Care Involvement Analysis Social Work Essay

Service User And Care Involvement Analysis Social Work Essay This review will consist of an introduction, aims of the review, and methods of data collection, findings on a series of questions and answers on the extent of service user involvement in the discharge process, conclusions, and possible recommendations for change. It will conclude with a reflection piece. The following review will discuss the issue of service user involvement in the discharge/transfer procedure. The review was compiled by the author within a nineteen bedded Forensic Mental Health unit. The ward was at full capacity at the time of writing this review. The service users all had different levels of mental illness, each with a different history, level of cognitive awareness, degree of institutionalisation and willingness to adapt and change. This review will assess to what extent service users are involved with the discharge planning process in the ward, if any, and give possible recommendations on how this process may be improved. Aims of the Review During this placement the author decided on a subject to review, this subject was service user involvement in discharge planning. While collating information for the review some questions arose these questions were: Does the service user feel included in decision making? How does the staff involve the service user in the decision making if at all? Has discharge been discussed with the service user? These questions lead to the author constructing some key questions to carry out in the review these will be discussed further in the findings. 91 Methods used to construct review The data for the review was collected over a ten week period within the ward. The author consulted service users notes, attended multidisciplinary team meetings and conducted a series of semi-structured, one to one interviews with service users and staff, including a consultant, doctors, ward manager, nurses, nursing assistants and occupational therapists. A literature search was also carried out using accredited databases including CINAHL and the British Nursing Index. Relevant journal articles were found on these databases using keywords such as service user, involvement and mental health services. Nursing research books were also used to gather information along with web sites underlining national policies and models for mental health nursing. 110 Findings How are decisions made within the placement area regarding discharge planning? A Forensic Mental Health Unit is not part of the prison services it is a service that specialises in the assessment and treatment of people who have a Mental Disorder. According to the Mental Health Care and Treatment Act 2003 a mental disorder is an illness such a personality disorder or learning disability defined by the act, whereby the mental disorder has been a contributing factor to the person offending. Throughout the weeks on this placement research was carried out by the author on policies and procedures for discharge planning. The one in particular that was found to be relevant was the Care Programme Approach (CPA). CPA is about early identification of needs, assignment of individuals or organisations to meet those needs in an agreed and co-ordinated way and regular reviews of progress with the service user and care providers. CPA is also about involving family or carers at the earliest point. The Care Programme Approach requires that service users should be provided with copies of their care plans and it has been increasingly common for service users who have been the responsibility of forensic psychiatrists to have copies of documents relating to their care. (DOH 2008). Systems were in place for comprehensive care planning. There was evidence to show that the service users social, educational and occupational needs were taken into account in the care planning process and other specialist interventions were available. In addition to this, in some cases, discharge/transfer planning was evident from an early stage (not long after admission), although in other cases a few months had elapsed before any document noted those discussions. Discharge planning is enhanced by the Care Programme Approach (CPA) a multi-disciplinary care planning systematic approach that involves service users and their carers. Care Programme Approach is the framework for care co-ordination and resource allocation in mental health services. Decisions for discharge are made through the multi-disciplinary team which consists of consultants, ward manager, nursing staff, occupational therapy and social workers. discharge guidance 4. This will go forward to a tribunal where the service user will be invited to take part, here all the evidence will be put forward and a decision will be made. If the service user is restricted then the decision will be made by the First Minister. When a service user is restricted it means an order has b een applied to them as they are seen by the act to be a more serious offender, this then means that the Home Office is responsible for granting discharge and a representative will be invited to the Tribunal (MHCT Act 2003 SECTION 37/41). Most service users have long term mental health problems and complex social needs and have been in contact with mental health services for more than twenty years so never think about discharge. Being in hospital for so long has become part of their lives so service users see it as pointless being discharged, what would I do. 488 SECTION 117 AFTER-CARE Prior to 1983, no statutory provision was made for the after-care of patients discharged from hospital. Section 117 introduced and defined formal after-care. In particular it stated: It shall be the ditty of the health authority and the local authority to provide in conjunction with voluntary agencies after-care services for any person to whom this Section applies, until such time that the health authority and local authority are satisfied that the person concerned is no longer in need of such services . Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49. Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patients needs for health and social care have been fully assessed, and that the care plan addresses them. The Section 117 meeting The aim of the meeting is to draw up an after-care plan, based on the most recent multi-disciplinary assessment of the patients needs. During the meeting the following areas should be covered as appropriate: Housing Finances Relationships/family Employment Social needs Psychology/mental health difficulties Relapse predictors Known risk factors When the care plan is agreed the team should ensure that a key worker is identified to monitor the care plan. The Care Co-Ordinator can come from either of the statutory agencies, and should not be appointed unless they are present at the meeting, or unless they have given their prior agreement.. The process for Sec 117 can be found in Trust Policy and Procedure and applies to all patients accepted by psychiatric services. What decisions/involvement does the service user have in this process? Within this placement the care and treatment plans are reviewed on a regular basis. Service users are expected to meet with their key worker and other team members on a regular basis, care plans are reviewed at these meetings and a mutual agreement will be decided, on the best way forward, once the care plan has been agreed by all the service user has to adhere to the care plan.(discharge guidance)no.16 Rights, Relationships and Recovery (2006): The Report of the National Review of Mental Health Nursing in Scotland Service users are encouraged to be fully involved in all aspects of their care as far as they are able to. Service users past and present wishes should be taken into account, their views and opinions with regards to their treatment plan must also be recorded, as stated in the Mental Health (Care and Treatment) Act Scotland 2003. These wishes and aspects will be turned into a care plan that is individual to the service user. The principles of the act underpin any decision made relating to a detained service user in Scotland. The Milan Committee devoted a chapter in the act that referred to high risk patients it stated that service users should have the right of appeal to be transferred from a high or medium secure facility to that of a facility with lower security conditions. (Mental Health Care and Treatment Scotland Act 2003). This however seemed to be the problem across the board, lack of medium/low secure facilities to discharge /transfer appropriate service users to. Service users have the opportunity for regular one-to-ones with their key workers (weekly basis) or more regularly if they require. Service users have the opportunity to put forward their thoughts on discharge and any other aspect of their care at the review, such as their rights, beliefs and their right to a tribunal. The author attended these independant tribunals while on this placement and at these tribunals people had stated that their human rights had been violated (The Human Rights Act 1998). They felt they were still being discriminated against for offences they had committed 20-30 years ago and feel they were being held under excessive security hence the reason for the tribunal to appeal against this level of security. this would mean they would be granted grounds access on a trial period which may be supervised, then become unsupervised for a trial period to see how the service user would cope, this in turn will lead to a further tribunal taking place in a set time agreed f or example 4 or 6 months away, where the service user may be granted discharge/transfer to a lower secure unit depending that all provisions that had been put in place had been adhered to, for example, risk assessment reviewed, treatment regime being followed, attend all social/therapy/strategy groups that were agreed. The review takes place every four months, again this is a multi-disciplinary meeting and service users are invited to attend with the support of advocacy or someone of their choice. The Human Rights Act 1998 gives legal effect in the UK to certain fundamental rights and freedoms contained in the European Convention on Human Rights (ECHR). These rights not only affect matters of life and death like freedom from torture and killing, but also affect your rights in everyday life: what you can say and do, your beliefs, your right to a fair trial and many other similar basic entitlements. During the time spent on this placement it was noted that service users and key workers met at the beginning of the week to discuss how they felt things had been for them, the service user has the opportunity to discuss what changes they would like to happen, this is then recorded in the service users notes and taken forward to the clinical team that week where it would be discussed if any changes in care and treatment would take place, the service user is then informed of any changes and decisions made which they have the right to appeal against (The Human Rights Act 1998). The opportunity arose for the author to take part in these weekly reviews, during this one-to-one time most service users were able to express their thoughts and feelings about issues they had encountered that week and describe what therapeutic strategies they used to get through it. The service user will be provided with a copy of the Treatment Plan Objectives, or informed in detail of the contents of the treatment plan, in the event that any learning or specific reading or language difficulty information should be provided in a way that is most likely to be understood. Arnstein (1969) constructed a ladder of participation which described eight stages of user participation in services, including mental health. These stages ranged from no participation to user controlled services. The above service users would be placed on the sixth rung of the ladder in the partnership range as they agree to share planning and decision-making responsibilities. Partnership Partnership, like community, is a much abused term. I think it is useful when a number of different interests willingly come together formally or informally to achieve some common purpose. The partners dont have to be equal in skills, funds or even confidence, but they do have to trust each other and share some commitment. In participation processes as in our personal and social lives building trust and commitment takes time. discharge guidance 16.6 908 Does this placement area reflect its practice on local or national policies regarding service user involvement in discharge planning? (Mental Health Care and Treatment Scotland Act 2003). (The Human Rights Act 1998). When asked their views on the subject the Ward manager and senior nursing staff presented documentation which reaffirmed current practice within the ward. The Ten Essential Shared Capabilities (ESCs) DOH (2004) he explained was the model now being followed on the ward, has just been implemented into this area of placement within the last two years, which the ward staff have adopted well by providing a person-centred approach as much as possible. This new person-centred model embraced the ethos of the above, and senior staff stressed that good practice dictated that service users have the opportunity to appropriately influence delivery of care and support. A review of policies and procedures as well as discussions with staff provided evidence that the policies were actually in place. Throughout the placement, the author noticed that efforts were being made all the time to nurse according to the new model. Included were regular one to one sessions between nurses and service users to hear their views and thoughts, these already took place before the ESCs were introduced. Moreover some staff do find it difficult to adopt the ESCs and the mental health act due to the restraints of the environment (secure ward); however they are prepared to embrace the opportunity for further education and support. 211 Identify barriers and constraints. Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patients needs for health and social care have been fully assessed, and that the care plan addresses them. Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49. While on placement and conducting this review the author noted that one of the barriers to effective involvement came from some of the service users, due to the complex nature of the area the service users had become institutionalised and found it difficult to be thinking about discharge at this stage in their lives, so they just accept the way things are and do not get too much involved as far as care plans are involved and just say what they think the staff want to hear. In secure settings engagement of service users in assessment and treatment can be difficult, as there is a potential risk of perceived coercion. Moreover with the lack of medium secure facilities around this can hinder service users from moving on within the specified time limit agreed, as there are no provisions. 138 Recommendations for Development SMART Most service users were more concerned about their futures and life post discharge. They wanted their time between now and then to be concerned with preparing them for discharge. It was frustrating for many service users that they felt that little in the way of such preparation was taking place. Continue to provide service users with support and skills needed appropriate to their function and skills already held, for example cookery groups, IT groups. Provide groups that enhance social skills such as coping strategy groups, anger management, alcohol/drug treatment/groups. High secure units should ensure that at the point of discharge patients have a copy of their discharge care plan in a suitable format which includes appropriate information about the circumstances that might result in their return to a secure mental health provision such as However a recommendation that high secure units should ensure that factors to be weighed in assessing relapse are part of the risk assessment included in the discharge plan of all service users. The National Service Framework for Mental Health states that Service users and carers should be involved in planning, providing and evaluating training for all health care professionals (Department of Health, 1999). This is the case in most health care provisions but for more education, training and information to be more readily available. Strengthening the user perspective and user involvement in mental health services has been a key part of policymaking in many countries, and also has been encouraged by World Health Organization (WHO) in order to establish services that are better tailored to peoples needs and used more appropriately. 265 Reflection In this review, I need to reflect on the situation that took place during my clinical placement to develop and utilise my interpersonal skills in order to maintain the therapeutic relationships with service users. In this reflection, I am going to use Gibbs Reflective Cycle Gibbs (1988). This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future. During the first week of placement I was encouraged to work closely with my mentor. This gave me the opportunity to orientate myself to the ward and get an overview of the needs and requirements of the service users. This also provided me with the chance to observe how the nursing team worked on the ward. During this time I had learned that if the concept of inter-professional working is to succeed in practice, professionals need excellent team working and communication skills. Good communication, as we have staged in our group work theory, (skills for practice 3) is crucial in the effective delivery of patient care and poor communication can result in increased risk to the service users. I have learned the valuable skills required for good communication and will transfer these into practice by adapting to the local communication procedures (expand). The NMC advices that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patients care (NMC, 2004). 256

Criticism of The Storm by Kate Chopin Essay -- Kate Chopin Storm Sexua

Criticism of The Storm by Kate Chopin While it has traditionally been men who have attached the "ball and chain" philosophy to marriage, Kate Chopin gave readers a woman’s view of how repressive and confining marriage can be for a woman, both spiritually and sexually. While many of her works incorporated the notion of women as repressed beings ready to erupt into a sexual a hurricane, none were as tempestuous as The Storm. Kate Chopin was a woman whose feminist viewpoints were far ahead of her time, which of course garnered her more than her share of criticism. In a time when women were expected to behave "properly" and sexual desire was considered to be something only experienced by men, Chopin spoke with exceptional openness about human sexuality. She lambasted society for its perpetual close-mindedness in a time when righteousness was considered to be an attribute, and she helped to generate more enlightened attitudes among both the women and men of her time. In The Storm, the character of Calixta is unable to fulfill society's standards of virtue, despite her perceived purity by her lover Alcee. When Alcee professes, "If she was not an immaculate dove in those days, she was still inviolate" (p. 34), he is basically saying that just because a woman is not chaste, does not mean she is not pure of heart. After all, it was Calixta's marriage which had stripped her of her chastity status. So why should her morality be called into question? Of course the morality i...

Midterm Essay Cj210-04

Midterm Essay Exam xxxxxxxxxxx Kaplan University CJ210-04 1. What are methods of inquiry and how are they used in criminal investigation? The main methods of inquiry are the reconstruction of the past and the discovery or creation of new knowledge. In order to reconstruct the past there are three sources available to the investigator. These are people, physical evidence and records. People are a good source of information once you learn the art of questioning and how to sift through the lies and deceptions. Physical evidence paints a picture or can accurately recreate a crime.Records are used to show an investigator trends leading up to the crime. Now the discovery or creation of new knowledge is what separates the skilled investigator from the rest. This involves instinct, experience, an open mind and what some consider gut feelings. You need to think outside the box. 2. What is the optimal mindset of an investigator and how are the concepts associated with the optimal mindset of an investigator manifest? I believe the optimal mindset of an investigator is to be wary of all. An investigator needs to believe all suspects are guilty until proven otherwise.Never dismiss a clue or lead and never let your guard down. The manifestation of this mindset comes with common sense, experience, training and traits that some people are just born with. I think some of these traits can be learned but the best of the best are born to be investigators. 3. What is the scientific method and how is it applied to criminal investigation by criminal investigators? â€Å"The scientific method is a way of observing, thinking about, and solving problems objectively and systematically. † The criminal investigator uses this process much like a mathematician solves a problem.They identify the problem then come up with a theory. Then they collect data through observations and experimentation. This then helps the investigator to draw conclusions. 4. Discuss the three primary sources o f information for criminal investigators and provide detailed practical examples of each source listed. The three primary sources of information for criminal investigators are physical evidence, people and records. Physical evidence is comprised of things found at a crime scene such as fingerprints, tool marks, bullets, casings, hairs, fibers and many other things.When it comes to people this includes friends, family, witnesses, victims, business associates and people that share the same recreational interests. An example of records could be phone calls, credit card purchases and video surveillance tapes from banks, parking lots, and just about anywhere you go anymore. References Osterburg, James & Ward, Richard (2010). Criminal Investigation: A Method for Reconstructing the Past. Sixth Edition. Anderson Publishing http://www. ncjrs. gov/App/Publications/abstract. aspx? ID=78300

A Comparison of Two Leaders

His upbeat personality and gentle style has made him one of the great leaders of the NFG. Although Ben Franklin lived a very long time ago, people still speak highly of the man and his accomplishments. English historian Lewis Simpson stated about Franklin that he was â€Å"always terse, luminous, simple, pregnant with meaning, [and] eminently persuasive† (Stout 613). Eugene Weber describes Franklin as â€Å"urbane, tactful, [and] dedicated† (Weber 19). Franklins good humor and outgoing personality helped him to be elected and selected for many different public offices during his life.Franklin was a man of few failings, but the ones he had caused him some serious trouble. While serving as the envoy to England, he would not listen to public opinions about America that did not fit with his views (Weber 19). This got him into trouble with the English and he left the country bitter towards Its citizens. Franklin also spent many years from home and away from his family. HIS r elationship with his son deteriorated until his son joined the British to fight against America and his father. Although I could not find anyone who had anything bad to say about Tony Dungy, he, eke Franklin, spent a lot of time away from home.NFG coaches spend many long hours at the office and many days away from home. This time away caused strains in his family relationships and may have been a contributing factor in the suicide death of his son Jamie In 2005 (Morning 34). When it comes to leadership styles both men continue to have a lot in common. Tony Dung's leadership style is a blend of both consideration and initiating structure styles. Tony likes to work with his followers leading them in the correct direction, but he also gives them lee way to make their own decisions.When off the field he uses a lolling approach to maintain order and keep his players in line. Jim Caldwell, Tony's Mentor Leader†. In the example Jim recalls Tony telling players to be good role models while showing clips of athletes that had run against the wrong side of the law (Dungy VII-VIII). While on the field he would use various styles from telling, to selling, and even a participating style allowing players to give input on what play to run next. It is this intense relational style that caused Jim Caldwell to declare that Tony Dungy leadership DNA perfectly fit the description off Level 5 leader (Dungy ‘X). WhileDung's leadership style was a blend, Franklin adjusted his leadership style to fit his role. While in public office Franklin displayed a directive style of leadership to get the job done. When working with the other leaders of the new America, Franklin took on an Advisory role (Lane 42). He used his wit and wisdom to guide and advise them through the new challenges that now faced them. He also used an advisory role while serving as envoy to England and France. In conclusion I would like to answer the question if they could have switched places in time. Even putting aside the vast difference in time and the fact that an AfricanAmerican would not have been accepted in Franklins position, I think the answer is no they could not have switched. Though both men exemplify what it is to be a leader, their roles in history and on those around them were very different. Franklin is an extrovert and enjoyed the public eye while Dungy is an introvert and would find it difficult to be around that many people all the time. Franklins fame is inexorably tied to his inventions as well, something Dungy could not have duplicated. Franklin, although fond of sports and the outdoors, I don't would have been happy in Just one career as a NFG coach.