systematic literature review

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Assessment of Nurses’ Workplace Silence Behavior Motives. For the current project. Don\’t work on the introduction. Start from the methods, Results, discussions and the implications

Patient/Family Refusal of Treatment-Policy

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influence the professional nursing role?

Mercy San Juan Medical Center

SUBJECT:
Patient/Family Refusal of Treatment

DEPARTMENTS:
All

PURPOSE:
To outline the process for handling patient/family refusal of scheduled treatments

POLICY:
notified if a scheduled treatment is refused.
Excludes:
a. Physician may indicate, “Patient may refuse” when prescribing the treatment. In such cases, do not notify the at tending physician if patient refuses the treatment
b. PRN (as needed) medications
c. Medications held in accordance with parameters prescribed by the physician.
d. Medications self-managed by the patient (eg: Insulin pump)

PROCEDURE:

  1. Attempt to understand the reason why the patient/family is refusing the prescribed treatment.
    Provide additional education or information about the treatment..
  2. The staff member providing the scheduled treatment will notify the attending physician the
    treatment was refused. Exception: If a laboratoryor radiology test is refused, laboratory
    personnel will notify the nurse caring for the patient. The nurse will then notify the physician.
    The staff member will contact the attending physician within a time frame that is reasonable for the treatment refused unless the licensed practitioner has, in their clinical judgment, deemed the situation to be urgent.
    i. The attending physician is defined as the physician who ordered the treatment being refused. If the ordering physician is not available, notify the physician on-call for the ordering physician
    ii. The physician of record for the day (the physician providing/supervising care) will be contacted if the ordering physician and on-call physician are not available. If the physician of record for the day is unavailable,
    additional calls will follow the Chain of Command (Division Chief, Department Chairman, Chief of Staff).
    iii. The staff member may refer to the attached script to guide their conversation with the physician. (see attachment 1)
  3. Document medication refusal on the Medication Ad
    ministration Record.
  4. The staff member will complete the ad hoc “Refusal of Care” form in the electronic record and forward the completed form to the appropriate physician. (see attachment 2 for screen shot of the form)

DEFINITIONS:

  1. Patient refers to the patient able to make his/her medical decisions
  2. Family refers to the decision maker or legal representative for the patient
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This agency’s policy influences the professional nursing role, due to the fact that it makes the nurse an instrumental healthcare practitioner in analyzing a situation in which a patient is refusing medical care, in order to ascertain the best methodology by which to help to address this problem effectively. The individual that is referred to in first observing that the patient is refusing their medication is referred to as the staff member that is providing the treatment within …

Do you think sensitivity analysis is essential for every economic evaluation?

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is essential for every economic evaluation? Justify your answer.
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each and every economic evaluation largely due to the fact that this form of analysis will provide the means by which to make a determination as to the effectiveness and reliability of the economic system that is being evaluated, in producing the best results possible under a tremendous variety of internal and external environmental conditions. Due to the fact that economics can be affected by a great deal of different variables at nearly anytime, it is absolutely essential that the economic system or model be analyzed in a way that helps to expose any weaknesses in the ability of the system to function under conditions in which variables behave in unexpected ways. Another reason that sensitivity analyses is essential for every economic evaluation, due to the fact that it provides keen understanding of the correlation and or …

Incremental Cost-Effectiveness Ratio

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. of incremental cost-effectiveness ratio (ICER).

  1. Using the data below, calculate the average and incremental ICERs. Assume that the options are mutually exclusive.
    Hint: Sort options according to cost.

Comment about the dominance of Beclomethasone over Salmeterol-high dose.

Indicate your choice when the 3-month budget is USD 200 and USD 300.

the existing one, and if your incremental threshold ratio is USD 500 per FEV1 unit, what are the feasible options?

Cost (USD) over 3-month study period
Placebo 60.00

Salmeterol: low dose 170.00

Salmeterol: high dose 360.00

Ipratropium 90.00

Beclomethasone 280.00

============================
Change in FEV1 (l)

Placebo 1.1

Salmeterol: low dose 1.5

Salmeterol: high dose 1.6

Ipratropium 1.3

Beclomethasone 1.7
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Hello, Thanks for using BrainMass. This should help to give you a clearer direction. Thanks and have a great day. Take care.
Dr. J

ICER-Cost Effectiveness
The concept of incremental cost-effectiveness ratio (ICER).

Part 1:
Incremental cost effectiveness ratio (ICER) often comes up when discussing drug comparisons, and facilitate the understanding of costs, as it basically tells us how much each additional unit of FEV1 costs using a particular treatment. In order to determine ICER, we must first order the treatments by cost, then calculate how an/the increase in cost for the next treatment increases the FEV1. In essence, ICERs relate the costs of a drug treatment to its clinical benefit in terms of a ratio expression, and can be directly compared to a pre-specified willingness to pay (WTP) benchmark, which usually represents the maximum costs that health care insurers would invest to achieve one clinical benefit unit (Krummenauer & Landwehr, 2005). Incremental cost-effectiveness ratio (ICER) = (C1 – C0) / (E1 – E0) wherein C1 is the cost of the medicine; C0 is the cost of the comparator technology; E1 and E0 are the consequences of the medicine and the comparator, respectively. As well, the change in effects is usually measured in terms of the number of life-years gained or quality-adjusted life years gained by the intervention (Gabi, 2010).
Part II:
Beclomethasone, Ipratropium and Salmeterol are used in the treatment and …

Care Management: Recommendations for Patient Needs

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Situation: Mrs. J is a 44-year-cholangiocarcinoma. She has been admitted to the hospital with a new onset of back pain, nausea, and vomiting. She is suffering pain from new spinal metastasis, nausea continuous, emesis daily, partially digested food, postprandial bloating, and early satiety. She has already undergone surgery and a course of radiation therapy. Other pertinent findings: well-hydrated; abdomen soft, mild distension, non-tender to palpation; denied abdominal pain; no abdominal masses; normal bowel sound; normal neurological exam. Current antiemetic order: ondansetron (Zofran) 4mg IV or PO Q 4-6 hrs prn. Continued despite no relief of N&V.

needs related to symptom management, the trajectory of her disease process, and broader treatment options/palliative care concerns.

QUESTIONS:

  1. Describe recommendations for prioritizing this patient’s needs – i.e. what issue(s) should be tackled first, second, third, fourth, fifth etc),
  2. Describe how they should be addressed, and what other members of the interdiscplinary team should be called upon for the needs beyond area of practice of a nurse.
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  3. Describe recommendations for prioritizing this patient’s needs – i.e. what issue(s) should be tackled first, second, third, fourth, fifth etc.).
    a. Pain control is your first priority. In fact, some of nausea may be due to pain. Since she has end-stage cancer with bone meds, narcotics are necessary. Since she may vomit oral medications, I would opt for IV Demerol instead of morphine sulfate since nausea and vomiting occur more often with …

Middle East Conflict Sources Research

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for the following research paper. The main focus is on the sources of the conflict which could be on the National or International level. These conflicts are generally very complex, and multi-faceted. The focus is hence, to identify possible source A and then explain it, and so on.

Part I – Background and Settings:
-The OVERALL conflict issue, and who are the parties or sides in this conflict.

Part II – Conflict Sources
– this conflict?

References are also appreciated.
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The main focus is ONLY on the SOURCES of the conflict which could be on the National or International level. These conflicts are generally very complex, and multi faceted. The focus is hence, to identify possible source A and then explain it, and so on to source B, C… (Not attempting to solve the Middle-East conflict)
Part I – Background and Settings:
The overall conflict is a disagreement about whether to hire U.S. expatriate workers for
an organization’s new location in Ireland or whether to use host country nationals. The company
provides recording, studio rental, and production services at a low cost to up and coming
musicians. Ireland is a great resource for new bands as the music culture is very active, which
makes it a good place for a global branch office.
Two global Human Resource managers have been assigned the task of filling the
Available positions in the Ireland location. The positions to be filled are studio manager,
assistant studio manager, 5 full time rental staff, 2 full time technicians, and 2 part time
technicians. The HR managers are at odds about the best way to fill the positions, in terms of …

Decision Making and Allocating Resources in Health Care

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drawbacks of explicit rationing in a health care setting?
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of explicit rationing is the fact that resource allocation decisions are made by higher-level administrative leadership. This is an advantage due to the fact that these individuals have a birds eye view of the resources that are available for utilization, and can therefore make a more informed and effective decision as to the resource allocation and distribution methodology that will be most effective in bringing about the most good for the most people. This is very important due to the fact that without this overall view of the situation there would be inefficiency in deciding what types of resources are most necessary to make available in abundance, in lieu of those resources that are not an absolute necessity at a given time. This will also help to prevent the exhaustion of resources that need to be made available more sparingly, so that these resources last for an appropriate time period.

Another advantage of explicit rationing is that …

The Six Dimensions of Health and Wellness

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dentify three of the six dimensions of wellness. Thespiritual and environmental wellness.
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Physical health is a balance of good cardiovascular fitness. Participating in activities using large muscle groups such as swimming, cycling, and jumping rope helps achieve optimal physical health. These fitness choices optimally should be done a minimum of four days a week for at least 20 minutes for each episode. Also, flexibility and strength are critical for maintaining good fitness. Strength can be enhanced with weights or doing activities using a repetitive motion and increasing the amount of weight. Dancing as well as stretching are beneficial for …

Stereotypes and perceptions about sensitivity

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1)How do stereotypes and selective perceptions impact an individual’s reaction with others?

2) How can individuals increase their awareness and sensitivity of others?
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  1. Children are like animals, in that they learn how their parents act and live. They copy reactions to emotional stimuli, physical needs and body language. The s. By the time a child is six years old they have learned most of what they need to be a separate and individual person.

Children who are ignored by parents will evolve to have emotional deprivation. They will need to develop a new way to fill the need. Appearance can reflect how a person feels inside or he can camouflage his inner-feelings by overdoing the outside …

Fall Prevention Education for Seniors

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on fall prevention for seniors with objectives, content, resources, case scenarios, and handouts.

  1. of conceptual frame work use with educational plan on fall prevention in seniors.
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The attached document is not intended as an assignment completion

Fall Prevention Education for Seniors
Objectives
Objectives are what you aim to accomplish with the education program. However, objectives
go beyond simply stating goals. Objectives are measureable, time sensitive, and specific. For example,
goals would be as follows:

  1. Increase awareness of hazards for falls
  2. Increase knowledge of fall prevention strategies
    Objectives are more specific and should apply to the specific target population. Your education program is not likely to target all seniors so identify the audience. It could be all seniors attending a senior center in a particular community, all seniors seeking medical care at a physician office or clinic, or all seniors within a city or geographic area. If your program requires attendance it is likely targeting seniors within a specific location so good object examples are listed below:
  3. Increase awareness of fall hazards among seniors at CYZ senior center by 75% within 6 months.
  4. Increase knowledge of fall prevention strategies among seniors at CYZ Senior Center by 50% in 2 months.
    Content
    This is the meat and potatoes of your education program. An outline helps organize content though it is not necessary. Break up content by topic and use a different heading for each new topic. …