Psychiatric rehabilitation Essay Example | Topics and Well Written Essays - 250 words - 1

Psychiatric rehabilitation - Essay Example Case management, outreach, and assertive community treatment are methods of adult mental health services. This extensive spectrum is the unlimited power of community mental health in that it delivers choices and permits persons to have access the variety and type of services and care that they wish to have. The main determinant of dissimilarities between assertive Community Treatment (ACT) and Community Treatment (CM) studies is the confined bed administration procedures and occupancy exercises. The organizational features of ACT that are commonly shared by CM crews are linked with decreased hospital care; nonetheless the severe staffing projected for ACT does not have any impact on it. ACT is thus a dedicated form of CM, not a definitely different method. The advantage of introducing it usually depends on the state of existing local practice. Significant lessons on the need to lay emphasis on treatments instead of structures appear not to have been studies. This is because Psychiatrys current excessive emphasis on service structures might have had involuntary results for the professional

Marketing Principles Coursework Example | Topics and Well Written Essays - 500 words - 1

Marketing Principles - Coursework Example The idea holds that achieving the goals of the company lie squarely in finding the needs of the market targeted. The company should come up with ideas that will persuade the customer’s needs by offering better products. Marketing concept relies on research carried out in the target market. Elements of the marketing process are sets of convenient tools. Such tools help the company’s blends to produce the impact it needs in the target market. There is a perception that if a company lowers the prices of the various commodities, the sales involuntarily increases. Such situations may be different. This is because customers may be looking for other components such as quality, cost effectiveness and value added services. An airline company which reduces its price by cost cutting in areas such as; airport charges, direct sales to the customers and lowering the advertisement costs may get profit in the long run (Pride & Ferrell, 2003). Placement involves all activities of a particular company that makes the products available to the target customers. A good example is the emirates airline that has continuously advertised its services to attract more customers. Promotion entails the means through which the companies communicate to its customers about their product’s values and benefits. Most companies in London have websites. Such websites act as a communication channel between the customers and the company. Market and product orientation are the two approaches of market orientation. Product-oriented approach involves a company developing products without having to focus on the customers’ needs. This kind of approach may often lead to unsuccessful ventures. A gas company in London may decide to introduce some new services without necessarily focusing on customers’ needs (Pride & Ferrell, 2003). Market-oriented approach; the company develops a product with a focus on the customers’ needs. The products developed lie squarely on the information obtained

Health and Safety Program Essay Example for Free

Health and Safety Program Essay With the aim to align with the standards set by the OSHA and ensure employee safety and protection, the company has decided to create a (1) formal safety program for employees and (2) reduce workers’ compensation cost. Given such changes, the company shall elaborate on important guidelines and information needed by each employee to actively avail of such incentives. The next section will highlight the coverage of such amenities and benefits Workers’ Compensation and Safety The creation of the workers’ compensation and safety plan seeks to ensure a fair practice among the employers and the employees with the aim of creating compromise between two parties in each ones needs. The following are included in the overall program: 1. Rehabilitation of Injured Employee 2. Insurance Coverage 3. Cost Allocation Workers Compensation Insurance With the formalization of compensation policies, the company will provide insurance to its employees based on the following: a. the company will use self-insurance as its form of option b. the determinant for premium rates shall be computed based on a manual rating and shall be determined by the Manager of Health and Safety Please note that casual employees (part-time) and contractors subcontractors are not subject to such changes. Coverage of Insurance and Safety Benefits The company will compensate workers and shoulder the expenses of employees who fit in the following categories: (1) Out of Employment Injuries, (2) Injuries during course of employment, (3) temporary disability and (4) permanent disability. With such initiative in mind, the company seeks to extend its arm towards its employees and wishes to assure each one that their welfare is taken care of. For the benefit of the workers and the growth of the company.

Reflective Essay On A Patient Undergoing An Acute Care Nursing Essay

Reflective Essay On A Patient Undergoing An Acute Care Nursing Essay Introduction This is a reflective essay that will be focusing on my experience and feeling on how I related with a patient who was complaining of severe pain in the surgical ward during my posting there. I will be using the Gibbs (1998) reflective cycle as a guide on this essay. The Gibbs (1998) Reflective Cycle which is one of the most popular models of reflections consists of six steps: Description which describes as a matter of fact the situation and what happened during the incident. For my case the management of this patient who was admitted and was being managed pre-operatively for intestinal obstruction; secondly, feelings which is the description or the analysis of what my thoughts and feeling were at the time of this incident. Thirdly, the evaluation of my experience: this is about what was good and bad about my experience. Fourthly the analysis of my experience about what I can make out of the situation. Conclusion is the sixth step and it is about what else I could have done and what c ould I not have done. The final step is the action plan. The action plan will be about what I will do if this situation arose again or what I will do differently bearing in mind my experience from the steps above (Jasper 2003). Reflective practice writing is a way of expressing and explaining ones own and others stories crafting and shaping to and understanding and development and it enables practice development because the outcomes of reflection are taken back into practice, improving and developing (Bolton 2005). Reflection is a way of learning from your direct experiences, rather than from the second-hand experiences of others (Cottrel 2003, p6). There are several other models of reflective practice. In addition to the Gibbs (1998) models, there are the Johns model of reflection (1995); Kolbs Learning Cycle (1984) and the Atkins and Murphys model of reflection (1994). Description During my placement at the acute surgical ward, I came across a patient who I will name Mr Jones (not real name). This is due to confidentiality. According to the NMC (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives article 5, 6 and 7, it states that You must respect peoples right to confidentiality; You must ensure people are informed about how and why information is shared by those who will be providing their care; You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising (NMC 2008, p2). When I arrived at the ward on the 8th of October, the senior nurse briefed us about the cases on the ward. I learnt that Mr Jones was admitted into the surgical ward with severe abdominal pain and he has been diagnosed with small intestinal obstruction and is being managed pre-operative for surgical intervention. While attending to the patients in the ward under the supervision o f my mentor (NMC 2008), Mr Jones called out to me that he is in severe pain. Walking up to him, I noticed the agony and pain he was in. Once he had my attention he was screaming and berating me that he is in terrible pain and that he need more pain killers. I approached Mr Jones and introduced myself with the aim of building an initial and good rapport with him and to establish a nurse-patient relationship (Holland et al 2008). I was so petrified with the signs and the way he communicated with me in such a way that really expressed he was in severe pain. I assured Mr Jones that I will have a word with a qualified nurse and will be back. I walked up to my mentor and ask that Mr Jones would need some pain killers as he is in severe pain. I was very surprise when my mentor said to me okay, where is Mr Jones drug chart? And to my utmost surprise, instead of getting a cocktail of pain killers for Mr Jones, she was asking several questions. How do you know that he is in such severe pain as you have just described to me? Have you asked him with the trust policy of pain scale? What type of pain killers has been given to Mr Jones and for how long ago were these given to him? She went on and on and I felt embarrassed and at same time very eager to correct my mistakes. I was unable to answer any of the questions she has asked. I guess I must have been overwhelmed with sympathy rather than empathy for the patient. I went to bring Mr Jones drug chart and my mentor explained to me that from his drug chart recordings, he is on oral morphine 10mg 4 hourly and the last dosage was given in just an hour ago. He would need a doctor to review to see whether he might need another route and dosage of the analgesic she explain to me. Feeling My first feeling was that this patient could be in severe pain and there is need to administer some form of strong analgesics. Pain according to the International Association for the Study of Pain is, An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP 1979). Pain may not be totally objective but subjective according to Braun et al (2003), they went on to further point out that included in pain are emotional as well as personal experiences. Pain could be divided simply into acute and chronic pain based on its duration (Shipton 1999). Acute pain is of short or limited duration usually associated with traumatic tissue injuries, whereas chronic pain is a pain or discomfort persisting for about 3 to 6 months and may persist beyond the healing period (Sinatra et al 2009; Ready and Edwards, 1992) and pain could progress from acute to chronic (Blyth et al, 2003). There is a psychological aspect to pain. According to Eccleston (2001), pain can be influenced among other things by culture, previous pain experience, mood, ability to cope or even belief. He concluded that pain is multifactorial and as such individuals should be treated differently. One of the underpinning principles of the Roper-Logan-Tierney model of nursing is the individualisation of nursing care and nursing practice (Roper et al 2000). My mentor showed me that Mr Jones is on 10mg oral morphine four hourly and that he may need a new review by the doctor so as to reassess his pain. I went to inform Mr Jones of this. On getting to him, I introduced myself with the aim of continuing our initial good rapport and also to obtain consent. According to the RCN Informed consent is an ongoing agreement by a person to receive treatment, undergo procedures or participate in research, after risks, benefits and alternatives have been adequately explained to them (RCN 2005, p5). Also, it has long been documented that information r educes anxiety (Byshee 1988 cited in Hughes 2005). I informed him that he will need a reassessment by the doctor in order to change his pain killer or if there is need to increase the dose and that the doctor has been notified of this. To my surprise, this seemed to calm him down a little as I explained and listened empathically to him. In a study carried out by Matthewson at the elderly care unit at New Cross Hospital in Wolverhampton, she concluded that nursing is the art of caring and as such we must listen empathically to what patients and service users want so we can give them the care that they deserve (Matthewson 2002). Evaluation This being my first encounter of meeting a patient with acute pain, I have so much to learn and gain especially about acute pain management. Having ask several questions and establish a good patient-nurse relationship (Holland et al 2008), I was involved in most of management of Mr Jones. Monitoring vital signs and recording them accurately. I learnt according to Mr Jones past medical history that he was first admitted in to the hospital in September 2009 for hernia repair and discharged home. He is now being treated for small intestinal obstruction which is one of the side effects of adhesions which could result from hernia repair (Ryan et al 2004). I asked the qualified nurse series of question and she informed me that caring for patients with intestinal obstruction require great deal of nursing skills. Patients suffering from small intestinal obstruction do have not only physical needs but also psychological and nurses should be aware of the fact that patients react differently to the fact that they are acutely ill (Hughes 2005). The ward sister informed me that some of the important factors to look out for when managing a patient with bowel obstruction are the presentation symptoms and vital signs such as pain, dehydration and fluid and electrolyte imbalance and nausea and vomiting. According to Anderson (2003) vital signs need to be monitored closely for changes by nurses and respond quickly and appropriately. After re-assessment by the resident doctor that responded to the summon, Mr Jones morphine was increased to 20mg, 4 hourly in titrated doses so as to minimize the effect of euphoria and unwanted effects. Also the route of administration was changed so as to quicken the onset of action. According to McQuay and Moore (1999) it is sometimes advisable to change the route of administration if the patient is still complaining of pain as oral and trans-dermal route may delay the onset in acute pain. All strong opioids require careful titration from an expert practitioner it is better to begin with a small dose and increase gradually in conjunction with careful assessment of its effectiveness (Hanks et al 2001). Analysis Despite the fact that Mr Jones has had a surgery to repair his hernia a year earlier and is about to undergo another one shortly, he was in very good spirit. The whole process from when I came into the ward and Mr Jones called out to me that he is in severe pain till now has all been eventful and educating at same time. Mr Jones was given morphine to manage his acute pain. Several preparations are available in the pre-operative period for pain management. These include intramuscular analgesics and opiates such as morphine (Hughes 2005). Morphine was used as a drug of choice in the management of Mr Jones acute pre operative pain. Though it has several advantages that are well suited for small intestinal obstruction management like its effect on slowing down the motility of the gut (Rodney 2010) which in the case of small intestinal obstruction is good, it causes nausea and vomiting as some of its side effect due to its direct action and stimulation of the chemoreceptor trigger zone of the brain (Daniels 2008). Though anti-emetics were prescribed to counter the effect of nausea and vomiting, their effect was not profound and this caused some delay in the operative process. Under the supervision of my mentor, I actively participated in the monitoring of Mr Jones vital signs. In addition to recording the temperature, I was involved in the monitoring of the fluid and electrolyte balance. Fluid balance was monitored hourly as one of the senior sisters explain to me the importance of a maintaining its balance. Haemodynamic stability is crucial as hypovolaemia can occur quickly because of the obstruction, fluid levels can rise quickly due to decreased gut movement causing the bowel to distend and losing its functionality of absorbing water and minerals thereby leading to fluid and electrolyte imbalance (Torrance and Serginson 2004). Conclusion I feel that the whole process involved in the management of Mr Jones pre-operative acute pain went smoothly. Being my first placement in the surgical ward I asked several questions and mentor and senior nurses were on hand to explain and in some instances demonstrate this out. But what else could I have done or what could I have done differently? Well, from the first time I went to meet the patient and then relaying the patient concern to my mentor, I should have looked at the patients drug chart rather than being overwhelmed by self pity. All documentation with regard to the patients management is on the patients record and it is vital that I look at this. Effectual documentation according to Porter and Perry (2009) within a patients medical record is an imperative and fundamental aspect in the practice of nursing. To minimize the risk of errors in the management of a patient, there is the need for accurate documentation of all drug activities in the patients drug chart (Youm 2002). As I have come to realize, pain may not be totally objective but subjective and included in this are elements of emotion as well as personal experience (Braun et al 2003). Rating scale are the most commonly used method of accessing acute pain and its relief. The World Health Organisation (WHO 1996) modified analgesic ladder to control pain in that the simple principle is that the beginning of pharmacological intervention begins on the first step of the ladder and proceeds upward. Opioids are used extensively in the management of pain and believed capable of relieving severe pain more effectively than non steroid anti-inflammatory drugs (NSAIDs) (McQuay and Moore 1999). Action Plan My action plan should a situation such as this arose again will be significantly different. I will continue to reflect and study how acute pain is managed and the role of the nurse in such management and most especially to ensure I look at documentation for patients. Effective pain management is fundamental to quality care, good pain control speeds recovery. To increase the effectiveness of nursing interventions and to improve the management of pain, the use of pain assessment tools for acute pain has to be followed such as verbal description scales(VDS) which are based on numerically ranked words such as none mild, moderate severe and very severe for assessing both pain intensity and response to analgesia. Numerical Rating Scales (NRS) this is easily used as a verbal scale of 0-10 indicating no pain on one extremity of the line and 10 indicating severe pain at the other extremity (Hammer and Davies 1998). Uncontrolled pain can lead to increased anxiety, fear, sleeplessness and muscl e tension which further exacerbate pain (Dougherty and Lister (2008). Perkins and Kehlet (2000) suggested that poorly controlled acute pain may lead to the development of chronic pain. I also learnt that there is a psychological aspect to pain. My nurse-patient relationship really helped in this area. According to Holland et al (2008) each patient should be regarded as unique in a nurse-patient relationship and that individuality should be taken into account when undertaking nursing care (Holland et al 2008 p11). Another aspect of nursing care that helped was effective communication which is an essential prerequisite for effective nurse-patient relationship (Robinson 2002). By talking to patient in an open, honest way about their pain made them feel more relaxed and in control which help them to cope better. I hope to increase my nurse-patient relationship and how to deal with acute cases. This will be a goal I will be aiming at in my next placement though discussion with my mentor and further research.

America - A Nation of Immigrants Essay -- Immigrants Immigration Unite

The North American economic development has seen several stages of development. The first stage of economic development was a plantation-slave economy mixed with mercantilism, the second stage of development was a competitive industrial economy, and the stage third stage of economic development is multinational capitalism. Economic institution and related governmental actions have formed the tides of migration and the resulting patterns of immigrant adjustment. The original groups of inhabitants in North America were Native Americans. These Native people lost much of their land and many of their lives to the vicious European invasions. Many groups of immigrants came to America, yet each group had left their native country for various reasons and under various circumstances. Some immigrant groups entered America as slaves, others came to work at low paying labor jobs, and some came as entrepreneurs. These various groups were discriminated against at varying level, depending on the resources the group brought with them. Those immigrants who made the journey to America on their own freewill with economic resources found that it was much easier to find good jobs than those immigrants with less than such freewill and resources. Small business opportunities unfortunately were not available for most immigrants. The waves of immigrant migration to the North America are highlighted in phases. With phase one came English colonists from the 1600’s to the 1800’s. The English created colonies and forced land from the native people. The English also established a form of capitalism. During this same time Africans were seized from their native lands and were shipped to America involuntarily in the form of property, to be used as slave labor. Also, phase one brought an era in which Irish Catholics immigrated to America, driven from their native land from the 1830’s to the 1860’s, due to famine, oppression, and poor living conditions. These Irish immigrants were able to obtain low wage jobs. Phase two began with the immigration of Chinese people from the 1850’s to the 1870’s; these people came due to recruitment efforts by the United States and in hope of obtaining better living conditions. The Chinese became employed mostly in construction, and menial service jobs. The Italians arrived between the 1880’s and the 1910’s. The Italian people were recruited for construction... ...e rioters to stop the violence. Despite the hostilities in different areas, Korean entrepreneurs are still committed to building successful businesses. By their successes in New York and Los Angeles, tin low-income neighborhoods, they have spearheaded urban renewal. (Articles and Papers, "Why Koreans Succeed" by Heather MacDonald, City Journal, Spring 1995) Koreans have been such a recent addition to the culture and mainstream of the United States, we cannot make general assessments of validity of their contributions to society. All indications appear to indicate they have made, and will continue to make, a positive, inspiring impact, as they continue to integrate our society. Large numbers of Korean immigrants came to this country as a result of the Korean War. American armed forces involved in the war, came back to the United States with wives and children. The larger influx of Korean Americans came after 1965, when a new immigration law was passed. Both groups, hardened by wartime and brutality, were filled with dogged determination to succeed. Overcoming prejudice and maltreatment, they are a positive addition to our country, which is still the "melting pot" of the world.

Ill Health Rates of Indigenous Australians Essay -- Sociology

As health professionals, we must look beyond individual attributes of Indigenous Australians to gain a greater understanding and a possible explanation of why there are such high rates of ill health issues such as alcoholism, depression, abuse, shorter life expectancy and higher prevalence of diseases including diabetes, heart disease and obesity in our indigenous population. Looking at just the individual aspects and the biomedical health model, we don’t get the context of Aboriginal health. This is why we need to explore in further detail what events could have created such inequities in Aboriginal health. Other details that we should consider are the historical and cultural factors such as, ‘terra nullius’, dispossession and social Darwinism, early attempts of genocide towards Indigenous Australians, segregation and the ‘protection’ legislation, the assimilation policy, self-determination and â€Å"the emergence of Indigenous protest† (Psych ology and Indigenous Australians, Foundations of Cultural Competence, 2009, pp.84) as well as the limiting factors of being part of a low socioeconomic status group and statistical health differences between Indigenous Australians and non-Indigenous Australians compared to other countries Indigenous and non-Indigenous populations. By encompassing all of these details, we can begin to establish why Aboriginal’s tend to have more health issues and what can be done to improve these health inequities. When the English settlers arrived on Australian shores in 1776 (The Story of the Australian People, 2010), they didn’t see anything that represented that the land was owned, so they claimed it as their own under ‘terra nullius’ in 1776. â€Å"In International Law 'terra nullius' describes territory that n... ...indigenousrights.net.au/section.asp?sID=33 Australian Museum. (2011). Indigenous Australia Timeline - 1901 to 1969. Retrieved May 5, 2012, from http://australianmuseum.net.au/Indigenous-Australia-Timeline-1901-to-1969 Department of Sustainability, Environment, Water, Population and Communities. (2008). Wave Hill Walk-Off Route more information. Retrieved May 6, 2012, from http://www.environment.gov.au/heritage/places/national/wave-hill/information.html Australia Bureau of Statistics. (2010). ADULT HEALTH: RISK FACTORS AND SOCIOECONOMIC STATUS. Retrieved May 6, 2012, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter750Oct+2010 Australia Bureau of Statistics. . (2010). ACCESS TO HEALTH AND COMMUNITY SERVICES: ACCESS TO HEALTH SERVICES. Retrieved May 6, 2012, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter955Oct+2010

Idea of Belonging

The idea of belonging is an important and fundamental value in our lives. Belonging most commonly emerges from experience and notions of identity, relationships, acceptance and understanding. The sense of belonging is represented in various ways throughout texts such asâ€Å"Ancestor† by Peter Skrzynecki and ‘China Coin’. Each of the texts has a wide range of ideas on how belonging is created though personal experiences and notion of acceptance and understanding. In â€Å"Ancestors† Peter Skrzynecki expresses a detachment from ancestors resulting in a lack of belonging in terms of relationship and understanding. Being separated from his heritage, the speaker experiences a kind of guilt about not being attached to his parents’ culture, but also a sense that this issue will have to be resolved, even if doing so may involve some distress and turmoil. The use of active voice in the poem shows – there are no passive voice verbs at all — his need to do something about the problem of belonging. The â€Å"bearded, faceless men† represent the shadow/spirit of his ancestors but the speaker may also be actually referring to photographs he has seen of these ancestors â€Å"standing shoulder to shoulder† – which also depicts the unity of these ancestors and the force they create is firm in his mind and forces him to find out what his roots are. â€Å"The eyes never close† shows that the moment is still and may be evidence that he is in a dream partly based on looking at such photos. A questioning tone also carries on throughout the poem. This questioning is about his identity though examination of the past which is represented by the ancestors, creating a sense of reflection and investigation on his relationship to his ancestors. But we can see that throughout the poem Skrzynecki is refusing to explore the past of these ancestors because he is afraid of the tainted, torturous past which stops him continued searching for a home: â€Å"To what star do their footprints lead? † This not only evokes his fear of the past but also shows that his uncertainty about re-rooting to his ancestral culture. The ancestors â€Å"Never speak â€Å"implying that those ancestors communicate to â€Å"you† in some other way. The poem is mainly a nightmare about the idea of ancestry/belonging, and Skrzynecki uses the blood allusion in â€Å"The wind tastes of blood† to show that the root is in our blood which connects us to our ancestors. However, the speaker’s sense of alienation from his ancestors has blocked his ability to belong and find the relationship between him and the ancestors. Blood† therefore limits our understanding of our past, which is what we originally belong to. Comparing to Peter Skrzynecki, Leah in The China Coin chooses to belong with her mum and her friends and being positive and happy. At beginning, Leah's relationship with her mum Joan was strained since she refers to her as the â€Å"evil aunt† â€Å"Joan†,evil aunt is a technique of metaphor,it shows nagetive feelings † Joan† is a technique of 3 rd person which sh ows the distance between Leah & â€Å"Joan. Espicially when Leah is lost during the student protest and result in a huge arguement with Joan†It's your rotten China. â€Å"presents again a big difference from Both Joan and Leah,through the emphasis on â€Å"your† and â€Å"from China with the describtive word â€Å"rotten† Comparing to Peter's relationship with his school and folk museum, Leah's realtionship with her mum at first was even more unstisfactory . But rather than running away and belonging to someone else,Leah has stayed with her mum and tried to fix this relationship. When she decides to end the conflict with her mother and rebuild the relationship,saying â€Å"It's over†Leah took Joan's hand and squeezed†we've been through a lot,eh†The action of squeezing echoes they are becoming closer. While Leah decided to belong to her Chinese culture,she also finds a second home. Even though Leah is reserved,the warmth and acceptance of this family draw her in,it's also for the first time Leah was thinking of Joan's family as her family. further more,Leah again builds relationships with family members Ke, Linan and uncle Tong. When the other half of the coin falls from the croll. Leah's reaction is positive†Li-Nan crushed her pounded her on the back and called her â€Å"sister† The symbolism of the strong hug and approval by Li Nan shows her acceptance into this family. Leah also build a special relationship with her cousin Ke. When Joan's in the hospital,Ke becomes the only one who Leah can depend on. She decides to build a relationship with him in order to belong with him. Since then,Ke refers to Leah with the word†mate†,This typical Australian word presents Ke accepted Leah and her clture. Also mate's a very positive word. It shows a positive relationship with people that's what it exactly represents here. Comparing to Peter's homeless, Leah both physically and mentally chooses to belong,therefore,she gets a positive and good result. Each of the texts shows us a strong will to belong and we can see that the ways people achieve belonging emerge from all these elements. Therefore it can be said that the texts have provided a wide range of ideas on belonging that support the statement that â€Å"a sense of belonging can emerge from experiences and notions of acceptance and understanding. †