Nursing Home and Acute Care Hospital Essay Paper

Identifying the Problem After working in both Nursing Home and the Acute Care Settings, I personally have noticed the big difference in the care of the Alzheimer’s disease patients and the elderly without AD. Caring for Alzheimer`s disease patients is more challenging for both the caregivers and health care providers. It is as stressful for both the patients and caregivers as they try to maintain their cognitive intact and as caregivers strive to make the patients feel as normal as possible. It is cumbersome to reverse or maintain the cognitive abilities. In this paper, will look how physical activities that is exercise if it can help maintain or sharpen the cognitive abilities in the patients with Alzheimer`s disease compared to adults over 60 who are without the disease.
The Setting Acute settings for the AD patients is a setback for them especially if they come from the nursing home where they are used to their usual routine and then it is disrupted. They get more confused and disoriented to their new environment. Mostly, they are placed on observation just to try and calm them down. What is lacking in the acute care settings is the continuity of physical activities in AD patients especially at our hospital.Nursing Home and Acute Care Hospital Essay Paper

 

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The aim of this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more of the following symptoms ‘temperature >38 degrees Celsius or 90 beats per minute, respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells per microliter or lower than 4000 cells 
The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask. An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output.
 This piece of work will be based on the pre-assessment process that patients go through on arrival to an endoscopy unit in which I was placed in during my second year studying Adult diploma Nursing. I will explore one patient’s holistic needs, identifying the priorities of care that the patient requires; I will then highlight a particular priority and give a rational behind this. During an admission I completed under the supervision of my mentor I was pre-assessing a 37 year old lady who had arrived to the unit for an upper gastrointestinal endoscopy. During the pre-assessment it was important that a holistic assessment is performed as every patient is an individual with unique care needs as the patient outline in this piece of work has learning disabilities it was imperative to identify any barriers with communication (Nursing standards 2006). Nursing Home and Acute Care Hospital Essay PaperThis essay deals with the holistic assessment of a patient who was admitted onto the medical ward where I undertook my placement. Firstly, the relevant life history of the patient will be briefly explained. Secondly, the Roper, Logan and Tierney model of nursing that was used to assess the care needs of the patient will be discussed, and then the assessment process will be analysed critically. Identified areas of need will be discussed in relation to the care given and with reference to psychological, social, and biological factors as well as patho-physiology. Furthermore, the role of inter-professional skills in relation to care planning and delivery will be analysed, and finally the care given to the patient will be evaluated.

Throughout this assignment, confidentiality will be maintained to a high standard by following the Nursing and Midwifery Council (NMC) Code of Conduct (2008). No information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Kate will be used to maintain the confidentiality of the patient.Nursing Home and Acute Care Hospital Essay Paper

The Patient
Kate, a lady aged 84, was admitted to a medical ward through the Accident and Emergency department. She was admitted with asthma and a chest infection. She presented with severe dyspnoea, wheezing, chest tightness and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diagnosed when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street away and visits her frequently. Her daughter stated that Kate has a very active social life; she enjoys going out for shopping using a shopping trolley.

The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the patient incorporating evidence-based practice concepts. This concept of precision education to tailor care based on an individual’s unique cultural, spiritual, and physical needs, rather than a trial by error, one size fits all approach results in a more favorable outcome  Nursing Home and Acute Care Hospital Essay Paper

The nursing assessment includes gathering information concerning the patient’s individual physiological, psychological, sociological, and spiritual needs. It is the first step in the successful evaluation of a patient. Subjective and objective data collection are an integral part of this process. Part of the assessment includes data collection by obtaining vital signs such as temperature, respiratory rate, heart rate, blood pressure, and pain level using an age or condition appropriate pain scale. The assessment identifies current and future care needs of the patient by allowing the formation of a nursing diagnosis. The nurse recognizes normal and abnormal patient physiology and helps prioritize interventions and care.[4][5]

Nursing Process

Assessment (gather subjective and objective data, family history, surgical history, medical history, medication history, psychosocial history)
Analysis or diagnosis (formulate a nursing diagnosis by using clinical judgment; what is wrong with the patient)
Planning (develop a care plan which incorporates goals, potential outcomes, interventions)
Implementation (perform the task or intervention)
Evaluation (was the intervention successful or unsuccessful)
Go to:
Function

The function of the initial nursing assessment is to identify the assessment parameters and responsibilities needed to plan and deliver appropriate, individualized care to the patient. Nursing Home and Acute Care Hospital Essay Paper

Appropriate level of care to meet the client’s or patient’s needs in a linguistically appropriate, culturally competent manner
Evaluating response to care
Community support
Assessment and reassessment once admitted
Safe plan of discharge

The nurse should strive to complete:

Admission history and physical assessment as soon as the patient arrives at the unit or status is changed to an inpatient
Data collected should be entered on the Nursing Admission Assessment Sheet and may vary slightly depending on the facility
Additional data collected should be added
Documentation and signature either written or electronic by the nurse performing the assessment

Summary Nursing Admission Assessment

Documentation: Name, medical record number, age, date, time, probable medical diagnosis, chief complaint, the source of information (two patient identifiers)
Past medical history: Prior hospitalizations and major illnesses and surgeries
Assess pain: Location, severity, and use of a pain scale
Allergies: Medications, foods, and environmental; nature of the reaction and seriousness; intolerances to medications; apply allergy band and confirm all prepopulated allergies in the electronic medical record (EMR) with the patient or caregiver
Medications: Confirm accuracy of the list, names, and dosages of medications by reconciling all medications promptly using electronic data confirmation, if available, from local pharmacies; include supplements and over-the-counter medications
Valuables: Record and send to appropriate safe storage or send home with family following any institutional policies on the secure management of patient belongings; provide and label denture cups
Rights: Orient patient, caregivers, and family to location, rights, and responsibilities; goal of admission and discharge goal
Activities: Check daily activity limits and need for mobility aids
Falls: Assess Morse Fall Risk and initiate fall precautions as dictated by institutional policy
Psychosocial: Evaluate need for a sitter or video monitoring, any signs of agitation, restlessness, hallucinations, depression, suicidal ideations, or substance abuse
Nutritional: Appetite, changes in body weight, need for nutritional consultation based on body mass index (BMI) calculated from measured height and weight on admission
Vital signs: Temperature recorded in Celsius, heart rate, respiratory rate, blood pressure, pain level on admission, oxygen saturation
Any handoff information from other departments Nursing Home and Acute Care Hospital Essay Paper

Physical Exam

Cardiovascular: Heart sounds; pulse irregular, regular, weak, thready, bounding, absent; extremity coolness; capillary refill delayed or brisk; presence of swelling, edema, or cyanosis
Respiratory: Breath sounds, breathing pattern, cough, character of sputum, shallow or labored respirations, agonal breathing, gasps, retractions present, shallow, asymmetrical chest rise, dyspnea on exertion
Gastrointestinal: Bowel sounds, abdominal tenderness, any masses, scars, character of bowel movements, color, consistency, appetite poor or good, weight loss, weight gain, nausea, vomiting, abdominal pain, presence of feeding tube
Genitourinary: Character of voiding, discharge, vaginal bleeding (pad count), last menstrual period or date of menopause or hysterectomy, rashes, itching, burning, painful intercourse, urinary frequency, hesitancy, presence of catheter
Neuromuscular: Level of consciousness using AVPU (alert, voice, pain, unresponsive); Glasgow coma scale (GCS); speech clear, slurred, or difficult; pupil reactivity and appearance; extremity movement equal or unequal; steady gait; trouble swallowing
Integument: Turgor, integrity, color, and temperature, Braden Risk Assessment, diaphoresis, cold, warm, flushed, mottled, jaundiced, cyanotic, pale, ruddy, any signs of skin breakdown, chronic wounds

Assessment of the Patient
Assessment Theory
In this ward, the Roper, Logan and Tierney model of nursing, which reflects on the twelve activities of living, is used as a base for assessing patients (Alabaster 2011). These activities are “maintaining safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobility, working and playing, sexuality, sleeping, and dying” Holland (2008, p.9).

Elkin, Perry and Potter (2007) outlined nursing process as a systematic way to plan and deliver care to the patient. It involves four stages: assessment, planning, implementation and evaluation. Assessment is the first and most critical step of the nursing process, in which the nurse carries out a holistic assessment by collecting all the data about a patient (Alfaro-Lefevre 2010). The nurse uses physical assessment skills to obtain baseline data to manage patients’ problems and to help nurses in the evaluation of care. Data can be collected through observation, physical assessment and by interviewing the patient (Rennie 2009). A complete assessment produces both subjective and objective findings (Wilkinson 2006). Holland (2008) defines subjective data as information given by the patient. It is obtained from the health history and relates to sensations or symptoms, for example pain. Subjective data also includes biographical data such as the name of the patient, address, next of kin, religion etc. Holland defines objective data as observable data, and relates it to signs of the disease. Objective data is obtained from physical examination, for example of blood pressure or urine.Nursing Home and Acute Care Hospital Essay Paper

Before assessment takes place, the nurse should explain when and why it will be carried out; allow adequate time; attend to the needs of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping patterns of the patient (Jenkins 2008). The nurse should also introduce herself to help reduce anxiety and gain the patient’s confidence. During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the colour of the skin, the eyes, and taking note of odour and breathing. An accurate assessment enables nursing staff to prioritise a patient’s needs and to deal with the problem immediately it has been identified (Gordon 2008). Documentation is also very important in this process; all information collected has to be recorded either in the patient’s file or electronically (NMC, 2009b).

Carrying out the Assessment
Kate was allocated a bed within a four-bed female bay. Her daughter was with her at the bedside. Gordon (2008) stated that understanding that any admission to hospital can be frightening for patients and allowing them some time to get used to the environment is important for nursing staff. Kate’s daughter was asked if she could be present while the assessment was carried out, so that she could help with some information, and she agreed. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a separate room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate’s daughter said it was fine for the assessment to take place at the bedside because her mother was so restless and just wanted to be next to her. The curtains were pulled around the bed, though William and Wilkins argued that it ensures visual privacy only and not a barrier to sound. NMC (2009a) acknowledges this, along with the need to speak at an appropriate volume when asking for personal details to maintain confidentiality.Nursing Home and Acute Care Hospital Essay Paper

The assessment form that was used during Kate’s assessment addressed personal details and the twelve activities of living. A moving and handling assessment form was also completed because of her immobility. First, personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also vital in order to correctly identify the patient to avoid mistakes. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Holland also insisted that religion should be known in case the patient would like to have some privacy during prayers, and this should be included in the care plan.

The second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: usual and current routines. Additionally, identifying a patient’s habits will help in care planning and setting goals. During physical assessment, when objective data was collected, Kate demonstrated laboured and audible breath sounds (wheezing) and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: blood pressure 110/70; pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 88%; peak flow 100 litres; weight 60kg; and body mass index 21. Taking and recording observations is very important and is the first procedure that student nurses learn to do. These observations are made in order to detect any signs of deterioration or progress in the patient’s condition (Field and Smith 2008). Carpenito-Moyet (2006) stated that it is important to take the first observations before any medical intervention, in order to assist in the diagnosis and to help assess the effects of treatment.

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Kate’s initial assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. Among the needs identified, breathing and personal hygiene (cleansing) will be explored.Nursing Home and Acute Care Hospital Essay Paper

Identified Care Needs
Breathing
Wilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The normal breathing rate in a fit adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less efficient, resulting in increasing efforts to breathe, causing a high respiratory rate. On assessment, Kate’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath.

Wilkinson (2006) explained that a goal statement is a quantifiable and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain normal breathing and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitoring her breathing rate, rhythm, pattern, and saturation levels. These were documented hourly, comparing the readings with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012) stated that it is very important to give psychological care to patients who are dyspnoeic because they panic and become anxious.

Checking and recording of breathing rate and pattern is very important because it is the only good way to assess whether this patient is improving or deteriorating, and it can be a very helpful method for nurses to evaluate whether or not the patient is responding to treatment (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates the need for oxygen. Blows (2001), however, argued that this can happen even after doing exercise, not only in people with respiratory problems. Griffin and Potter (2006) stated that, respirations are normally quiet, and therefore if they are audible it indicates respiratory disease. Nurses needs to be aware of these sounds and what they mean, for example a wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need.Nursing Home and Acute Care Hospital Essay Paper

Oxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National Formulary ((BNF)) 2011a). Nevertheless the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen and she maintained her oxygen saturation between 90 and 94%. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is another method that is used to assess the effectiveness of the medication (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication is administered. It is the Trust’s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal. Kate was observed for any blueness in the lips and tongue and for oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce inflammation in the airway (BNF 2011b). Kate was also started on antibiotics to combat the infection because, on auscultation, the doctor found that the chest was not clear.

Kate was nursed in an upright position using pillows and a profiling bed in order to increase chest capacity and facilitate easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being checked. Pulse rate and blood pressure were also being checked and recorded because raised pulse can indicate an infection in the blood.Nursing Home and Acute Care Hospital Essay Paper

Cleansing
Due to breathlessness and loss of mobility it was difficulty for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is needed to maintain health, for example bathing, mouth washing and hair washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the inner organs against injuries and infection (Hemming 2010). Field and Smith (2008) stated that personal cleansing also stimulates the body, produces a sense of well-being, and enables nurses to assess the patient holistically. Personal hygiene is particularly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). Therefore this need was very important for Kate; she needed to maintain her hygiene as she used to, before she was ill.

The goal for meeting this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining consent from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s usual habit is very important because each individual has different ideas about hygiene due to age, culture or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, especially in private areas. Kate indicated that she didn’t mind being assisted with washing and dressing. She preferred washing daily, shower and a hair wash once a week, and a mouth wash every morning and before going to bed.

Kate was assisted with personal care 5-10 minutes after having her medication, especially the nebuliser. Individuals with asthma experience shortness of breath whenever they are physically active (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.Nursing Home and Acute Care Hospital Essay Paper

The Role of Inter-Professional Skills
Considering Kate’s age and condition, she needed multi-professional teamwork. NMC (2008) encourages teamwork to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping people with breathing problems. Since Kate was on oxygen since admission, the respiratory nurse taught her the importance of healthy breathing and taught her some breathing exercises to help wean her from oxygen. Kate was also referred to the physiotherapist who did breathing exercises with her. Kate was not able to walk without aid so she was also referred to the occupational therapy department to assess how she was going to manage at home, or if she required aids to help her manage the activities of living. Upon meeting together, all the multi-disciplinary team agreed that Kate needed a care package, as she could no longer live without care. She was referred to social services so that they could assess this aspect of Kate’s future.

After one week Kate was medically fit but could not go home because she was waiting for the care package to be ready. Her nurse shared information with the multi-disciplinary team in order to establish continuity of care for Kate. The team prepared for her discharge: the occupational therapy staff went to visit her home to check if there was enough space for her walking frame; social services arranged for a care package; and her nurses referred her to the district nurse to help her with her medication and make sure it did not run out.Nursing Home and Acute Care Hospital Essay Paper

Outcome
Kate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with minimal assistance. She was discharged on a continuous care package comprising care three times a day, and the district nurse helped her with the medication to control her asthma.

Evaluation
The model of the twelve activities of living was followed successfully on the whole. The nurse collected subjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike.

A multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because the care plan was not yet in place.Nursing Home and Acute Care Hospital Essay Paper

Assessment can also take a long time, especially with the elderly who are usually slow to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking further steps. However, poor staffing also affects performance in this area, an observation supported by the Royal College of Nursing (2012).

In conclusion, the assessment of this patient was completed successfully, and the deviation from best practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one flaw in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages.

This assignment will discuss and analyse the nursing care given to an 85 year old female patient, during a four week hospital practice placement. In order to fully comply with the Nursing and Midwifery Council (NMC) Code of Conduct (2008), full consent has been verbally granted by the patient to utilise personal clinical information for the purpose of this case study. To ensure patient anonymity, throughout this assignment the patient will be referred to as Rose (Swift).
Chapelhow et al (2005) states, in order for a novice to become an expert practitioner there are several enablers which are fundamental to the nursing care that Rose received. These are: communication, assessment, managing risk, documentation, decision making and managing uncertainty. For the purpose of this assignment, the enablers of assessment and communication in relation to the care that Rose received will be discussed.Nursing Home and Acute Care Hospital Essay Paper
Background
Rose Swift is a retired teacher, a widower and is a mother of two sons. Rose was admitted to the accident and emergency department (A&E) via ambulance following an unexplained fall at home. Upon admission to A&E, Roses’ medical notes stated Rose had recently been diagnosed with Dry Macular degeneration, which is an age related chronic eye disease, causing loss of vision in the centre field (Samuel, 2008, Watkinson, 2010). After a short stay in a general medical ward for treatment of a urinary tract infection, Rose was transferred to an intermediate care ward for further rehabilitation, before being discharged home with a care package. Prior to admisson Rose lived alone, was independantly mobile with a stick and would cook her own meals.
Assessment
The Royal Marsden (2011), regards initial nursing assessments as a step to providing an individualised patient centered nursing care plan. By conducting nursing assessments, key information is obtained to aid the improvement of Roses’ health and develop a plan of care, which will ultimatly enable Rose to establish control of her own health (The Royal College of Nursing (RCN), 2004). However, as cited by Chapelhowe et al (2005) nursing assessments are far from static. As part of the nursing assessment process, a set of individualised outcomes are agreed, in collaboration with the nurse, Rose and the multidisiplinary team. These outcomes are continously evaulated by the nurse, in order to moniter Roses’ progress and where nessescary clincal judgement will be used to adjust these outcomes to suit the needs of Rose (Estes & Ellen, 2013).
For a successful assessment to take place, it is argued a sufficient baseline knowledge is required by the nurse (Peate, 2012). In contrast however Chapelhowe, et al (2005) argue that base line knowledge alone is not enough. Irrespective of how knowledgeable a nurse maybe, without effective communication and interpersonal skills, the care the nurse provides to Rose will be limited as Roses’ individual needs may not be met. It is therefore considered that a combination of the two is thus required (NMC, 2010).
Throughout Roses’ hospital journey, there are several assessments that took place. During Roses’ initial admission to A&E, the nurse conducted a systematic `mini’ assessment to obtain a rapid outline of Rose from both a visual and physical point of view (The Royal Marsden NHS Foundation Trust, 2011). As the resusitation council (2005) points out, inital nursing assessments in acute settings enable preservation of life, by providing fast intervention where required, using the Airways, Breathing and Circulation (ABC) algorithm. By asking Rose questions and obtaining qualitive information, the nurse established that Rose was breathing, had a clear airway and brain perfusion as well as establishing vital background information to aid diagnosis (Fawcett & Rhynas, 2012). In addition, the nurse was also able to quickly access Roses neurologial state using the Modifed Glasgow Coma Scale (MGCS) (Jennett & Teasdale, 1977).
When a patient such a Rose sustains a head injury, the National insititute of Health and Care Excellence (NICE) (National Insitiute for Health and Care Excellence, 2014) recommends the use of MGCS. According to Pillay (2013), MGCS provides a tangible way of noting the concious state of Rose, it is a widely recognised and accepted standarised practical assessment tool, designed for ease of use (Jennett & Teasdale, 1977) which has been used for many years at both a national and international level. When used repeatedly, MGCS can indicate the progression of a brain injury (Teasdale, et al., 2014), this in turn can aid decision making (Nursing Times, 2014). Recently however, there has been some criticism against MGCS regarding the tools ease of use (Mattar, et al., 2013). McLernon (2014) questions if the MGCS tool is still fit for purpose, citing reduced reliability due to lack of clinical consistency and poor communication between professionals. It is therefore suggested that a remedy of a uniformed approach and concise communication between professionals is essential, to ensure safe theraputic practice.
Whilst conducting Roses’ MGCS assessment the nurse noted a reduced score on account of Rose presenting symptoms of delirium. Farne, et al., (2010) states new confusion in patients can often be caused by underlying medical conditions. By utalising this knowledge, this enabled the nurse to apply her professional decision making skills, in order to continue with further assesssments which included a set of observations.
Observations (also known as vital signs) enables the nurse to check Roses’ basic bodily functions such as temperature, pulse, respiration rate and blood pressure (The Royal Marsden NHS Foundation Trust, 2011). A fundamental part of the asessment process, observations allow the nurse to obtain a baseline figure in order to carry out a continous assessment and evaluation, and enable the nurse to establish the level of care that Rose requires (Wheatly, 2006). To identify the risk of Rose deteriorating further, as per Nursing and Midwifery Council (2008) guidelines, each quantitive result was charted correctly, concisely and legiblibly by the nurse and given a score using a modified early warning score (MEWS) (Department of Health, 2000). After combining all results, the nurse was then able to establish that Rose was scoring a MEWS for a raised temperature and increased pulse in addition to a reduced MGCS. By drawing on previous experience and knowledge, the nurse was able to evaluate the overall asssessment, to establish that the presenting symptoms could indicate Rose has some form of an infection. This could be the reason for the fall and delerium (Schroeder, 2010). To rule out a urinary tract infection, a urine dip stick test on a midstream urine sample was conducted. This test showed positive for leukocytes and nitrates, indicating a positive infection result (Little, et al., 2009).Nursing Home and Acute Care Hospital Essay Paper
In order to treat Roses’ symptoms the doctor prescribed antibiotics, providing treatment under the biomedical model. Considered a dualistic approach, this model treats the mind and body as separate entities. Fast acting in its approach it treats the immediate problem (Mehta, 2011). However, in order to provide truly effective care the biomedical model alone is simply not enough. It is considered by many professionals that a holistic viewpoint should be taken (The Royal Marsden NHS Foundation Trust, 2011). Id est, in addition to Roses’ physical requirements, consideration should also be given to her emotional and social needs (Chapelhowe, et al., 2005). The psychosocial model should therefore also be considered, in order to treat Rose from a holistic perspective (Chapelhowe, et al., 2005).
Given Roses’ confused state of mind, unsteady gait and MEWS score it was decided to admit Rose to a general medical ward. In order to assess Roses’ psychosocial and cultural needs, the Activities of Daily Living (ADL’s) model (Roper, et al., 2000) was used. ADL’s is a systematic framework, which recognises Roses individuality and beliefs. It considers twelve fundamental concepts and provides a continuum in recognition that dependency can change throughout time (Roper, et al., 2000). Kearney (2001) argues however, that the care Rose receives maybe jeopardised using this model, due to its inflexibility and complex structure. To alleviate this, The Royal Marsden (2011) therefore advises that the nurse should use a pragmatic approach, and use the ADL framework as a guideline for professional decision making. In Roses’ case the nurse was able to utilise the ADL framework to identify a change in care needs. Due to Roses confused state and unsteady gait, assistance would now be required with washing, dressing, mobilising and other essential care needs as defined by the Department of Health (2010) in the Essence of Care guidelines.
Communication
Effective communication is an essential skill which enables the expert nurse to build a therapeutic relationship with Rose (Chapelhowe, et al., 2005). According to Dwamena, et al., (2012), communication is considered to be a significant factor in the rapid recovery of Rose. Throughout Roses hospital journey there are many ways in which the nurse interacts with Rose. However, as cited by The Royal Marsden (2011), interpersonal communication skills are the most widely used medium in nursing and arguably the most important skill.
In order for interpersonal skills to be effective Arnold & Underman Boggs (2011), states the nurse must consider several elements such as, verbal and non-verbal exchanges of information, active listening and observation skills. As the initial assessment process is often the first interaction Rose may have with the ward staff, Rose maybe reluctant to share information (Perry Black, 2013). The Royal Marsden (2011), recognises this could be a potential barrier for the nurse to deliver effective care to Rose and key communication factors such as environmental and nurse time restraints maybe contributory to Roses’ unwillingness to share information. To aid the nurse in overcoming this issue, (Cotoi & Ilkiescu, 2013) suggests a trusting environment should be created. Trusting environments enable Rose to feel safe and supported and provide a platform where Rose will feel comfortable and confident in sharing information with the multi-disciplinary team (The Royal Marsden NHS Foundation Trust, 2011).Nursing Home and Acute Care Hospital Essay Paper
In order to assimilate meaningful information from Rose, the nurse utilised her communication skills effectively in a number of different ways. An example of this would be, during the initial assessment process. When Rose was admitted to the ward, in line with NMC (2010) Code of Conduct to ensure privacy and dignity is maintained, the assessment took place in a cubicle, with the door closed thus creating a quiet environment. The Royal Marsden (2011) states a quiet environment during assessments is essential to enable Rose to maintain optimum concentration and remain complicit in her responses. Past research has shown discrepancies can often occur between the nurses understanding and that of Rose during assessments (Lauri, et al., 1997). A quiet environment therefore enables the nurse to focus solely on Roses responses, to maintain a meaningful interaction and deliver effective individualised therapeutic care (The Royal Marsden NHS Foundation Trust, 2011).
To ensure effective non verbal communication takes place, body language should also be considered. White, et al., (2011) states body language can be a powerful means of sending a message to Rose, therefore a postive open posture should always be maintained. Throughout Roses hospital journey it was noted the nurse positivly adapted her body language to suit the needs of Rose. An example of this would be when conducting assessments the nurse sat facing Rose, kept an open posture and maintained regular eye contact. These interations are considered by Egan (2002), to be fundamental elements of non verbal exchanges, in order to achieve optimum levels of communication.
As specified by the nursing and midwifery Code of Conduct (2008) optimum communication is an essential nursing skill. To be proficient, the nurse should respect Roses right to be involved in the decisions of her care (NMC, 2010). During discharge planning the nurse demonstated the proficient use of communication, when a conflict occurred between Rose and her family. Acting as an advocate, the nurse conveyed the wishes of Rose to return to her home against her sons wishes. Xxx xxx states during discharge planning, conflict can often occur due to lack of communication. To remedy this, the nurse utalised her commuication skills by asking open ended questions to asscertain the reasons behind the familys anxieties. Questions that are open ended allow the answer given by the receiver to be expanded and explored xxxxx xxxx. However XXX XXX states questions alone are not enough. In order to gauge the true meaning of the answer, non verbal signals should also be observed xxx xxxx.
In conclusion in order to provide effective nursing care to Rose the nurse must ensure that a thourgh assessment is conducted. This cannot be fully completed however, without effective communication skills, concise documentation and decision making. Each enabler is therefore interlinked to provide individualised holistic nursing care to Rose. As a nurse, good communication is vital to build a positive theraputic relationship with Rose and to enhance the relationship there are a number of factors the nurse should be aware of such as enviroment and non verbal communication prompts. Good interpersonal skills are therefore an essential nursing skill to aid the recovery of Rose.
The purpose of this essay is to describe the holistic assessment of a
66 year old male patient who has been admitted to hospital for bowel
surgery following the diagnosis of a cancerous tumor. The operation
will result in the patient having a part of his bowel removed after
which the patient will require a colostomy bag for the elimination of
feces (see patient profile in appendix 1 for further details). A
Pseudonym will be used to protect the patient’s confidentiality and he
will be referred to as ‘Peter’ in this essay which is in line with the
nurses’ code of conduct guidelines (NMC 2002). Nursing Home and Acute Care Hospital Essay Paper

The process of the assessment will be described along with the nursing
model chosen. The nursing model gives the student nurse a framework to
help direct and guide her throughout the assessment process (Aggleton
and Chalmers, 2000). The Roper, Tierney and Logan model (1986) has
been chosen as it is the model the ward follows for all assessment
procedures. The assessment process using the Roper, Tierney and Logan
model is holistic because it relates to the study of the human being
as a whole rather than its individual parts. A holistic view point
includes two basic beliefs: 1) The individual always responds as a
unified whole, 2) Individuals as a whole are different from and more
than the sum of their parts (Pearson, Vaughan and Fitzgerald, 2000).
Thus the assessment process would not be as accurate if you
concentrated on individual systems or parts of the human body.

There were a number of nursing priorities identified, the patient also has hypertension. The key priority for nursing care with this patient is her learning disabilities and the potential communication barriers that may occur. The patient’s hypertension is well controlled with medication for these reasons I will focus this assignment around communication barriers with people with learning disabilities, the importance of good communication between the multi-disciplinary team within the unit. I will also explore any issues with consenting to the procedure as it is imperative that the patient is fully aware of the procedure and understands the possible risks and complications.

This material illustrates Holistic Nursing modalities as practiced with individuals who are mentally ill. Holistic Nursing attends to the individual as an integrated person, caring for their mind, body and spirit. Modalities practiced elicit an individual’s intrinsic healing potential. Holistic Nursing defines health as a state of inter-relatedness of one’s values to the expression of such values. In the absence of such inter-relatedness, comes suffering. Multiple healing modalities are performed.Nursing Home and Acute Care Hospital Essay Paper

Frisch, Dossey, Guzzetta, Quinn (2000)1identify multiple modalities currently practiced including

a) finding meaning outside oneself (spiritual guidance)

b) establishing a trust relationship (cognitive therapy)

c) modeling appropriate behavior (behavior modification)

d) daily diary entries (journaling)

e) maintaining exercise regime (exercise and movement)

f) planning meals (weight management)

g) establishing relaxation skills (meditation) and

h) encounter-based problem solving (rehearsed diplomacies) These modalities are essential when caring for patients with mental health concerns.

The following case study examines case management evolving into Intensive Case Management (ICM) as an example of a healing modality and a holistic professional nursing practice 1, 2, 3.

The case study chronicles a patient’s struggle to function coherently. Storytelling is a descriptive way to communicate the factual basis of challenging truths. Health professionals use narratives, retrospectively, to depict case studies (Woodside, 2010) 2. Narratives link historical events to create a holistic interpretation of results.

This material establishes Intensive Case Management (ICM) as:

1. A Holistic Nursing modality

2. A Holistic Nursing modality practiced within settings where professional Intensive Case Management (ICM) professional nursing services are delivered2.

A Holistic Nursing modality may be practiced independently under the aegis of an Intensive Case Management (ICM) contract. Licensed, accredited, certified and educated, described in the literature as Advanced Practice Nurses(De Nisco, S., & Barker, A.M., 2013) 3, practice Intensive Case Management (ICM), outside the typical employer-employee relationship, as a Nurse Contractor.Nursing Home and Acute Care Hospital Essay Paper

The goal for nursing practice has always been to heal the whole person in body, mind and spirit. The focus on the wellness and interrelationship of people and the environment dates back to the practices of Florence Nightingale, a 19th century nurse who is considered the founder of holistic nursing. Yet it wasn’t until 2006 that the American Nursing Association (ANA) recognized holistic nursing as a specialty.

The incorporation of a holistic, person-centered approach to patient care continues to gain importance, especially with the ongoing changes in healthcare reform. The practice of viewing the individual, family and community as an interconnected system can help with disease prevention. It encourages patients to become more involved in self-care to work on their long-term health and wellness goals. Lamar University recognizes the importance of a comprehensive holistic health assessment and includes this course within its online RN to BSN curriculum.

What Is a Holistic Health Assessment?
A holistic health assessment goes beyond focusing solely on physical health. It also addresses emotional, mental and spiritual health. The whole condition of the patient is taken into consideration for ongoing wellness across the lifespan. The development of a relationship with the patient begins with open, therapeutic communication. This supportive, non-judgmental method of assessment recognizes that the patient’s stress levels, diet and relationship issues can often exacerbate many ailments.

A holistic health assessment allows the nurse to gain information essential for diagnosis, planning and implementation. It shows respect for the patient’s preferences and preserves the patient’s dignity. The six aspects of a holistic assessment include:Nursing Home and Acute Care Hospital Essay Paper

Physiological: Complete a physical assessment.
Psychological: Review potential stressors that might exacerbate the ailment.
Sociological: Discuss family networks and who can help at home.
Developmental: Consider how psychosocial and cognitive development may affect the patient’s response to the health issue.
Spiritual: Respectfully ask about religious and spiritual practices and determine if nursing care will need to be altered.
Cultural: Discuss special diet, values or culture-specific requests.
Integrating the six aspects of a holistic assessment into the nursing assessment can help identify an underlying cause of the illness or whether other factors are delaying recovery. Nurses can use this approach to glean information regarding the patient’s family dynamics, values, beliefs and other factors that would inform the care delivered and the patient’s healing. This can result in more effective treatment and optimal health. Lamar University offers an online comprehensive holistic health assessment course in its RN to BSN program that can help nurses build upon existing assessment skills.

What Does It Really Mean for Nurses?
The practice of holistic health nursing is based on the premise that self-care is necessary to effectively care for others. Nurses who practice holistic nursing incorporate a philosophy of responsibility to the self and a commitment to integrate self-care into their personal life. They strive to increase their awareness of their connection to the environment and remove barriers to the healing process. This allows them to provide more comprehensive care.

Holistic nurses combine mainstream and complementary, or alternative healing modalities (CAM). Some of these modalities include meditation, massage, deep breathing, natural products, yoga or music. Offering more treatment options suitable for different lifestyles provides patients a greater healing potential.Nursing Home and Acute Care Hospital Essay Paper

Why Is Holistic Health Nursing Important?
More hospitals recognize and utilize integrative health services. Unlike other specialties that are defined by a client group or a disease category, holistic nursing can be practiced in almost every area of care and in all settings. This patient-centered, practical and sustainable approach to well-being can be beneficial to patients of any age. The authentic, real relationships developed by utilizing the practices of holistic nursing can be beneficial to the patient and rewarding for the nurse.

There’s a special feeling you get when you come to Christian Health Care Center (CHCC). You’ll quickly sense that this is a place where people care. You will meet people who are dedicated to those they serve as well as those with whom they work; people who want to make every day the best it can be. You’ll find a friendly camaraderie among residents as they embrace life, and a sense of peace among families whose loved ones are receiving best-in-class clinical care in a compassionate environment. It’s an intangible quality that is the result of so many little and not-so-little tangible acts of caring.

Holistic nursing focuses on promoting health and wellness. It is care that is based on the theory of a balance between the body, mind and spirit. Its goal is to heal the body person as a whole. Holistic assessment is a practice that is specialized on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with their patients. It recognizes and gathers information about the totality of the human being, the interconnectedness of body, mind, emotion, spirit, socio-cultural, relationship, context, and environment. This paper is based on a holistic assessment of a patient from my job. A 72 years old Caucasian.Nursing Home and Acute Care Hospital Essay Paper
Developmental
The patient, Mr.N.G, a 72 year old, Caucasian male from Silver Spring, Maryland. He is divorced with three adult sons. Mr. N is a college graduate with a degree in the science. The level of educational level of a patient is important because it affects the way they act towards their physical and mental health assessment and also help them make healthy choices. It also helps the nurse to determine the level of the patients understanding and also help in communication. The patient’s physical development is one of weak, frail, kyphosis, and ambulation with assistance. He has had a femoral fracture, cataracts surgery, and is a fall risk. Despite the patients’ condition, his level of memory and cognitive activities are the patient’s memory and thinking (cognitive) abilities are strong. He is able to provide his date of birth and that of his children and also his address from memory. Patient communicates very well with the nurses and doctors and gives a clear feedback, also patient uses clear and logical speech when articulating.

Holistic nursing focuses on promoting health and wellness. It is care that is based on the theory of a balance between the body, mind and spirit. Its goal is to heal the body person as a whole. Holistic assessment is a practice that is specialized on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with their patients. It recognizes and gathers information about the totality of the human being, the interconnectedness of body, mind, emotion, spirit, socio-cultural, relationship, context, and environment. This paper is based on a holistic assessment of a patient from my job. A 72 years old Caucasian.
Developmental
The patient, Mr.N.G, a 72 year old, Caucasian male from Silver Spring, Maryland. He is divorced with three adult sons. Mr. N is a college graduate with a degree in the science. The level of educational level of a patient is important because it affects the way they act towards their physical and mental health assessment and also help them make healthy choices. It also helps the nurse to determine the level of the patients understanding and also help in communication. The patient’s physical development is one of weak, frail, kyphosis, and ambulation with assistance. He has had a femoral fracture, cataracts surgery, and is a fall risk. Despite the patients’ condition, his level of memory and cognitive activities are the patient’s memory and thinking (cognitive) abilities are strong. He is able to provide his date of birth and that of his children and also his address from memory. Patient communicates very well with the nurses and doctors and gives a clear feedback, also patient uses clear and logical speech when articulating. Nursing Home and Acute Care Hospital Essay Paper

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Holistic assessments in nursing provide a unique quality of care to the individual patient. Holism in the provision of care includes assessments obtaining data about the physiological, psychological, sociological, spiritual, developmental, cultural and environmental aspects. It is imperative that the nurse conducting these assessments adopts methods in the nursing process that reflects the standards outlined in Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse to ensure the health and wellbeing of the patient is maximized and maintained throughout the time health care is received. Nursing processes are directed at restoring overall harmony for the patient therefore an understanding of the…show more content…

Assessment in the nursing process will establish the patients’ ongoing needs and provide a quality of care best suited to the individual, to achieve a desirable health outcome. Cultural aspects of holistic assessment is relevant in the provision of nursing care as it provides the care team with an overview of cultural needs of the patient as well as providing information in which the patients’ health problems have arisen. Culture is defined as values, beliefs, artifacts, behaviors, attitudes and customs influencing and regulating interactions between members of a social group (Stein-Parbury 2010: 91; Johnstone 2006: 67). It is the nurses responsibility to adhere to the ANMC, competency 2.3, ‘accepts individuals/groups to whom care is provided regardless of race, culture, religion, age, gender, sexual preference, physical or mental state’ (ANMC 2006, p. 4). Kozier & Erb (2012: 360)

Hospital is an important part of the overall economy in the United States. Health care and Hospital expenditure in the United States is the highest among the 30 high income countries in terms of per capita and percentage of gross domestic product. Within the last few years, the relative price of health care has been slightly increasing.

It is worth specifying what has Economics to do with Hospital? As it is quite known about almost all industrial sectors of the economy, the resources to satisfy unlimited human wants are limited. From the economic point of view about Hospital and Health care, the resources are scarce, and the selection over various patterns of the available resources must be made with ideal decisions so as to minimize opportunity costs.Nursing Home and Acute Care Hospital Essay Paper

This piece of research work is an attempt to analyze the economic factors of Hospital Industry. This work presents ‘hospital’ industry and its economic activities as part of health care industry. This research paper includes detailed analysis of economic traits of hospital Industry, Porter’s five force analysis, the major economic and environmental change and the relative driving factors for the change.

Typical Los Angeles, California Hospital

There are a very large number of Hospitals of both Profit and not for profit, ranging from small health centers to highly sophisticated super specialty hospitals in Los Angeles, California. ‘Hospital’ is the organization whose principle purpose or function is to provide medical care to patients with many different types of ailments.

Health care district was authorized by the section 32121 of California Health and Safety. California’s district hospitals are considered to be public Hospitals and they are categorized under State’s other public hospitals. Public Hospitals can achieve funding from the federal government as is already done by District hospitals by using intergovernmental transfers to get additional funding (Association of California Healthcare Districts).Nursing Home and Acute Care Hospital Essay Paper

SIC/ NAIC codes and hospital industry reports

The North American Industry Classification (NAIC) was established for using as a standard for federal statistical agencies and for classifying the business organization so that statistical data related to a business and economy of US can be effectively collected, analyzed and published. The hospitals are included in Health Care and Social Assistances that are classified under the NAIC code of ’62’. Establishments in health care are presented with six digit NAIC code starting from ‘621111’ which is for offices of Physicians to ‘624410’ which is for child day care services (naics.com). General and specialty hospitals are classified under the NAIC codes starting from 622 (Hospitals) to 622310 (Specialty (except Psychiatric and Substance Abuse) Hospitals).

Establishments that provide health care, medical care and social assistance for individuals are included in NAIC codes of 62. The total number of Health care and subsectors are accounted to be 824,110 (naics.com). Industries in Hospitals and its subsectors provide a number of services including diagnostic, medical care and treatment services that comprise of physician, nursing and health services to the patients. Hospitals also provide outpatient services. The services offered by establishments in Health care industry are delivered by trained professionals and many of the industries are defined based on the educational degree that practitioners hold.Nursing Home and Acute Care Hospital Essay Paper

Hospital Industry and Dominant Economic Traits

Hospital industry is a significant part of Health care industry. According to the Bureau of Labor Statistics (2010), health care industry including hospital industry was one of the largest industries in 2008-2009. Health care sectors provided 12.3 million jobs for both wage and salary paid workers in the US in 2008. Out of the 20 fastest growing occupations, 10 are related to Hospitals and health care industries. Heath care is proposed to generate around 3 million new wage and salary job opportunities from 2010 to 2018 which accounts to be more than any other industry (BLS). A greater majority of the workers in the industry are highly qualified with graduation, post graduation and PhD levels and they are more trained and knowledgeable than other industries.

A very large number of hospitals and other healthcare establishments that are accounted to be 824,110 that makes up the total of health care industry in the US. According to Bureau of Labor Statistics, hospitals constitute just 1 percent of all healthcare establishments, but they employ 35 percent of all workforce. Hospitals employ more than 4.3 million workers. These establishments include a wide range of hospitals from small clinics to highly sophisticated multi specialty hospitals and other offices. Around 75 percent of health care establishments are comprised of physicians, dentists, surgeons, doctors and others including nurses.Nursing Home and Acute Care Hospital Essay Paper

According to the Bureau of Labor Statistics (2010), hospitals provide complete medical care including diagnostic services, surgery and continuous nursing services. Different hospitals are specialized in different areas like treatment for mentally sick people, treatment for cancer diseases, hospital for children etc (BLS, 2010). Hospital workers are qualified with higher education and professional training and they are provided of better opportunities than offered in nursing or other sectors of health care industry. It was estimated that around 20 percent of hospital jobs are in service occupation like nursing, psychiatric etc. Apart from the surgeons, doctors and other medical professionals, hospitals employ a large number of management and administrative staffs as well.

Cutler (2000) emphasized that hospital industries include a mix of three modes of production they are government, for profit and not for profit hospitals. As of 1995, 65 percent of acute care hospitals were in not for profit sector, 24 percent were public institutions and 11 were in for profit institutions (p. 1). But this has been changing for last few years. No matter how many they are, these three modes of hospitals provide same services in the health care market and they involve in competition.

With in recent years, the hospital industry has been facing the fluctuation that the pace of technological innovation and advanced and managed health care has caused in reduction in numbers of inpatient demand. Even when population was growing, it was accounted that the total number of ‘hospital days’ spent in the United States was reduced by 35% between 1980 and 1995   Nursing Home and Acute Care Hospital Essay Paper

The US hospital industry includes around 6500 hospitals that contribute annual revenue of more than $ 500 billion per year. Major companies work in the hospitals industries are Kaiser, HCA (Hospital Corporation America), Tenet Health care etc. Health Management Associates operates around 59 hospitals throughout rural areas and Community Health System operates around hundreds of hospitals in many states of the US. Community Health Services, LifePoint Hospitals, MedCath and Catholic Health Initiatives are some other major companies that involved in hospital industries in the US.

Demographics and advances in medical care and the technology used are the drivers for the demand for hospital. Even though different hospitals provide almost similar kind of services, the profitability depends on each one’s effectiveness in providing the services with the use of advanced technology and innovation. When large hospitals compete in the market with advanced services, multi specialty facilities and so on, small hospitals compete by providing specialized services in specialized areas.

The major revenue come from in-patient hospital care (it makes up of around55% of the industry) and out-patient services where in customers do not require to stay overnight, selling of prescription drug, surgeries, contributions and funding etc.

Economic Factors of Hospital Industry

The basic economic factors of any industry are demand, supply and the distribution. Similarly, the market for hospital and health care is controlled by the factors namely demands for health care, supply and distribution of the same. McGuire and Henderson (1998) argued that, economically, health is not a commodity, but health care can be considered to be a commodity that is exchangeable through health care centers like hospitals and nursing home (p. 33).Nursing Home and Acute Care Hospital Essay Paper

Health care is a process in which certain inputs are combined to bring out the output. According to Jacobs and Rapoport (2004), health care is a process in which factors of production like hospital services, medical instrument and equipment services and pharmaceuticals are combined in different quantities so as to yield an output (p. 18).

McGuire and Henderson (1998) argued that health care is a heterogeneous commodity and also an intermediate commodity in the sense that it not consumed for itself. He emphasized that the matters of being heterogeneous and intermediate is because there is clear difference between a simple head ache and brain tumor (p. 40). More specifically, it is not always clear about whether the head ache is a symptom of a more dreadful condition or not. All these may be because of poor information that patients have about their diseases even when they feel a simple headache. According to McGuire and Henderson (1998), for the above reason and other reasons, the nature of the commodity health care can be perceived differently on the two side of the market, that is, the distinction between what is wanted which is ‘health’ and what is supplied which is ‘health care’ (p. 40).

Five Force Analysis of Hospital Industry

The Five Force Analysis of Michael Porter (1979) helps an economist and marketer contrast the competitive environment of a particular industry. This model has been widely considered to be a useful tool in conducting an external analysis of the industries. the five force analysis helps us determine the severity of the competition in the market and the market overview with regard to seller, buyer and suppliers.Nursing Home and Acute Care Hospital Essay Paper

Figure below shows Hospital Industry’s five force analysis that helps gain a thorough understanding of Hospital Industry by analyzing five forces of its external environment. This analysis would help determine the competitive situation and profit potential of a particular industry.

Figure 1

The threat of New Entrants

The first element of the five force analysis is the potential threat of new entrants in to the existing market. Hospital Industry is normally considered to be a flexible one and entering in to the market is quite easy as compared to other industries as there the competition is severe and fierce.Nursing Home and Acute Care Hospital Essay Paper

The threat of entrance can be occurred due to many reasons like need for capital, need for brand awareness and economies of scale etc. Government regulations can constrain hospital industry. The government regulations restrict the types of services that can be provided by hospitals. It means hospitals entrants cannot easily manage or existing hospitals cannot expand without showing greater need for the general health care from the community side. Feldman (2000) emphasized that government regulation of the hospital industry stems from a fundamental constraint and destruct of market solution in health care context. Federal government in the US has played vital role in expanding regulatory control on hospital services. Regulation, re-regulation and de-regulation are continuously happening in various parts of the country today (p 172).

There merging and acquisition process can happen between hospitals instead of directly expanding the physical facilities and thus they can expand with current facilities. But, Federal Department of Justice viewed that this type of merger and acquisition and business combination is a violation of the Sherman Antitrust Act that has brought restriction on competition.Nursing Home and Acute Care Hospital Essay Paper

Power of Suppliers

The power of supplier is a significant force in the Porter’s five force analysis. As in any other industry, supplier has vital role in influencing the market through the raw-materials and resources that they can hold and subsequently they can influence the costs. Licensed, qualified and experienced medical personnel are a scarce in the Hospital industry. The US economy faces lack of nurse and medical practitioners.

Ivanov and Blue (2008) argued that a severe shortage of nurses exists in the United States and even with a large number of foreign trained nurses who are now working in the United States. According to estimation, the undersupply of nursing will reach 800,000 by 2020 (p. 174). According to Jonas (2003), the U.S department of Health and Human Services estimated the nursing shortage to be 350,000 in the year 2000 and 875,000 in the year 2020 (p. 39).

Hospitals need to compete against nursing homes for the skilled clinical workers. Hospitals need to compete against nursing homes for the skilled clinical workers. As adequate qualified nurse cannot be hired, the employers will be compelled to find workers from outside agencies by offering higher pay. This can create economic trouble in the country.Nursing Home and Acute Care Hospital Essay Paper

When price of the pharmaceuticals dramatically increase day by day, this increase can be a burden on many third parties and patients are unable to meet their need. As hospitals have recently entered in to capitation program and they agreed to offer the services only for a fixed amount per patient; this can be negotiated in anticipation of more increase of prices for pharmaceuticals. This can have a negative impact on the profit margin of the Hospitals.

Substitute Products

Another important force of Porter’s analysis is the availability of substitutes in the market. The availability, prices, qualities and features and even its advertisements can have major impacts in on the business strategy. The alternative medicines like acupuncture, music therapy and naturopathy are becoming a trend among many people even when these medicines fail to provide innovative and technological assistance for their practice.

Treweek (2006) found that alternative therapies are mainly used for chronic diseases like back pain, allergy, anxiety, depression etc. The research showed that there was amazing increase of 47.3 % in the visits to alternative practitioners, from 427 million to 629 million. The personal expenditure on alternative medicines was estimated at $ 2.7 billion in 2007 (p. 368).

Apart from the alternative therapies that still remain as growing challenge on the Hospitals, the private outpatient surgery centers, blood test units etc situated out of the Hospital also van have significant negative impacts on the revenue of the Hospitals.Nursing Home and Acute Care Hospital Essay Paper

The Power of Buyers

Another important element of Porter’s five forces is the bargaining power of buyers. This element shows the extent to which the buyers are able to bargain in the industry. Majority of the hospital payments are made by third parties like insurers and consumers make around 10 % of the total payments. As far as consumers are concerned, they make very less portion of the payment and hence they are least bothered about the prices being charged by the hospitals. The payments made by ‘Medicare’ and ‘Medicaid’ represent about 60% of the total hospital payments. The bargaining power thus seems to be less compared to other industries.

Competitive Rivalry

The fifth factor of the Five Forces Analysis is the competitive rivalry. The degree of competition that exists among the hospitals, degree of pharmaceuticals differentiation, cost conditions and other competitive factors can have significant influence on the industry. Shi and Singh (2009) put forth the fact that nonprofit hospitals compete head on with for profit hospitals. Competition among US hospitals commonly occur in the same communities for the same patients with revenues coming from the same public and private third part sources (p. 193).

The Porter’s five force analysis can help understand the external environmental factors that influence the competitive strategy of the industry.Nursing Home and Acute Care Hospital Essay Paper

Drivers of Change in the Hospital Industry

There have been tremendous changes in the Hospital Industry in the recent years. The Modern hospital has become a figure that functions with the help of a number of advanced technologies like X-rays, scan, laparoscopic surgery, bypass surgery etc. More specifically, hospital is a centre where even common people come to know about various technologies used in the health care practices. The major drivers for the changes in the Hospital industry includes New Technologies, Patient Family centered Space and Competitice forces.

Latest Technologies

The hospitals are increasingly looking for information technology in order to make health care more effective and to bring better cost effective medical care practices. Apart from the very commonly used techniques and technologies around the world, wireless patient record keeping and advanced imaging technologies have become new trends throughout the hospitals.

Technologies bring over all changes in the way the hospital is functioned. Hospital can improve its in-patient and out-patient services and it can thereby provide services with the help of technologies that help time saving and gain cost effectiveness.

The general criticism of technology and its application to the industries is that ‘Technology replaces the workers and creates unemployment’. But, as far as health care is concerned, the relative risk involved in creating unemployment is much lower than any other industries and also it should be perceived from the point of view that bringing technological change is imperative for efficient health care practice.Nursing Home and Acute Care Hospital Essay Paper

Dranove and White (1999) stated that technology can play vital role in health care in two ways: through changes in the technology of offering medical care and through changes in information technology. The changes in Hospitals due to the technology and innovation will be understood overtime that changes in Hospitals have been determinants of cost and quality care (p. 13).

Patient and Family Space:

A worldwide trend that can be found in hospital industry is that both patients and their families are increasingly demanding facilities within the hospital so that they can experience ‘home-like’ atmosphere. The growing numbers of super specialty hospitals with increased number of single family rooms and facilities like restaurants show that patients and their families demand comfortable stay facilities in the hospital. This trend can have dramatic impact on the hospital industry in the coming future.

Goldsmith (00) is of the opinion that the concept of family-centered care is as old as organization, but, is recently getting growing attention from the hospital management due to the increase of its demand from the patients and their families (p. 51). Hospitals have recently adopted the strategy for facilitating family space and providing amenities within the hospital premises. These include family centered maternity care, mother-baby care room, holding nursery and respite area, family room for dining and resting during the postpartum time etc.Nursing Home and Acute Care Hospital Essay Paper

Competitive Pressure

Hospital industry is highly competitive. Most hospitals in the US are characterized by relatively highly competitive with strategies of providing quality services and use advanced technology. The trend of fierce competition and using competition tools in the Hospital industry can drive a number of changes.

In the US, for profit and not for profit hospitals compete each other to attrcta more number of customers. While thinking from the view point of competition in health care to gain more number of patients, it can be considered that this competition can in turn decrease the value of health care. Porter and Teisberg (2006) argued that the struggle to accumulate bargaining power has led health plans to merge and compete each other to gain as many members as possible. But, gaining more number of people has little impact on the value of health care (p. 41).

Environmental Changes in Hospital Industry within last 5 years

Hospitals were undergoing various environmental changes in recent years. The environmental changes include economic, legal, technological and other changes. Almost all sectors within the US economy and worldwide economy have faced the severe and worst economic crisis in the history. This has brought many challenges and changes on hospital industry.

Economic Changes

Hamilton (2008) reported that hospitals have been facing unpredictable cash flows because of delayed payments from Medicare and health insurance companies because of economic crisis (bnet.com). Even though consumers have to spend little on the payment for the health care, the economic crisis hit insurance companies that in turn resulted in delayed payments.Nursing Home and Acute Care Hospital Essay Paper

Businesswire.com (2009) reported that most of the hospitals ( 60 % ) were found vulnerable to the economic crisis in the surveys conducted. The report highlights are:-

* 60% of the respondent hospitals have seen vulnerable to the crisis

* 47% of the hospitals foresee staff cuts (It is an economic change with larger impact on the economy)

* 73% of the respondent hospitals were found as increasing their cost of care related to meeting new safety standard

* 84% hospitals were attempting to reduce spending

These show that recent economic crisis has brought many economic changes on the hospital industry.

Organizational Changes

Pindus and Greiner (2010) described that the key organizational change in the hospital industry include a move towards outpatient based care and nursing homes. There was a move to managed care and an increase in the number of for profit health care providers. Changes in ownership and management patterns have been reflected in the concentration of hospital industry by the way of merger and there was an increase in the for profit hospitals as well. (urban.org).

Patient care change

In order to satisfy the growing demand for family centered care and amenities from patients and families, hospitals have undergone facilitating family centered care units and providing amenities. The changes were found in the organizational and workplace cultures within the hospital industry (Pindus and Greiner, 2010).Nursing Home and Acute Care Hospital Essay Paper

Technological Change

s discussed earlier, hospitals are common symbols of technological changes. In recent years, hospitals in the US introduced a number of technological assistances in diagnosing and treating the patience. Radiation therapy in oncology seems to be a very advanced step forward as it helps millions relieve from the severe ailment and pains of cancers. Bar code technology and wireless communication technology have recently been brought to the health care so that errors can be reduced and effective communication can be maintained.

Potential changes in the Hospital Industry

Internet style computing was a target of many hospitals in the US and now it is going to be real within near future. The Obama government’s plan to spend 19 billion US dollars to bring the electronic health record system will potentially give a forward motion to the dream of internet-style computing (Lohr 2009).

The electronic health record

The electronic health care project is designed to deliver individually tailored public health information and alerts to electron health record in the offices of concerned doctors. The detailed description regarding the ailment, patient’s location and age and symptoms will be passed on to the offices through electronic health record system and the doctors will be informed of patient’s dangerous conditions.

Internet associated facilities can bring major changes in information transfer and in handling effective communication. Web-based facilities will enable physicians and workers to collaborate and perform Health care tasks in an easier way. Patient and medical research information is moving to digital forms instead of paper forms. So, the application of natural language processing to health care will be becoming of vital importance in the near future (Lohr, 2009).Nursing Home and Acute Care Hospital Essay Paper

Pharmacy Benefit Management

Pharmacy benefit management depends on technological advances mainly in the field of biotechnology. Combinatorial chemistry will enable Pharmacy Benefit Management to deliver more effective and same time expensive pharmaceuticals.

Kongstvedt (2007) describes how Pharmacy Benefit Management can be made useful with the help of combinatorial chemistry and throughput. High throughput and combinatorial chemistry will allow a geometric improvement in the number of chemicals

It’s no wonder, then, that CHCC is known for the exceptionally broad range of services we offer seniors—whether they lead active and independent lives, need a little assistance with daily activities, or are in need of 24-hour nursing care. In fact, CHCC offers the area’s most complete continuum of services and lifestyle options on one campus, with a dedicated staff that includes full-time, on-staff specialists such as physicians, dietitians, clinical nurse specialists, geriatric nurse practitioners, chaplains, physiatrists, counselors, social workers, and physical, occupational and speech therapists. The significant skills of our staff members are complemented by the use of advanced technology including iN2L interactive software for residents, wi-fi service, online video communication services, and electronic medical records.

We are committed to promoting health, healing, and wellness at every level and every stage of life. From our adult day services, assisted living, and independent-living neighborhoods to dementia care and skilled nursing, it is our goal to help each individual attain his or her highest potential for physical, mental, emotional, and spiritual well-being.Nursing Home and Acute Care Hospital Essay Paper

For Americans to enjoy optimal health—as individuals and as a population—they must have the benefit of high-quality health care services that are effectively coordinated within a strong public health system. In considering the role of the health care sector in assuring the nation’s health, the committee took as its starting point one of the recommendations of the Institute of Medicine (IOM) report Crossing the Quality Chasm (2001b: 6): “All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.”

This chapter addresses the issues of access, managing chronic disease, neglected health care services (i.e., clinical preventive services, oral, and mental health care and substance abuse services), and the capacity of the health care delivery system to better serve the population in terms of cultural competence, quality, the workforce, financing, information technology, and emergency preparedness. In addition, the chapter discusses the responsibility of the health care system to recognize and play its appropriate role within the intersectoral public health system, particularly as it collaborates with the governmental public health agencies.Nursing Home and Acute Care Hospital Essay Paper

The health care sector in the United States consists of an array of clinicians, hospitals and other health care facilities, insurance plans, and purchasers of health care services, all operating in various configurations of groups, networks, and independent practices. Some are based in the public sector; others operate in the private sector as either for-profit or not-for-

profit entities. The health care sector also includes regulators, some voluntary and others governmental. Although these various individuals and organizations are generally referred to collectively as “the health care delivery system,” the phrase suggests an order, integration, and accountability that do not exist. Communication, collaboration, or systems planning among these various entities is limited and is almost incidental to their operations. For convenience, however, the committee uses the common terminology of health care delivery system.Nursing Home and Acute Care Hospital Essay Paper

As described in Crossing the Quality Chasm (IOM, 2001b) and other literature, this health care system is faced with serious quality and cost challenges. To support the system, the United States spends more per capita on health care than any other country ($4,637 in 2000) (Reinhardt et al., 2002). In the aggregate, these per capita expenditures account for 13.2 percent of the U.S. gross domestic product, about $1.3 trillion (Levit et al., 2002). As the committee observed in Chapter 1, American medicine and the basic and clinical research that inform its practice are generally acknowledged as the best in the world. Yet the nation’s substantial health-related spending has not produced superlative health outcomes for its people. Fundamental flaws in the systems that finance, organize, and deliver health care work to undermine the organizational structure necessary to ensure the effective translation of scientific discoveries into routine patient care, and many parts of the health care delivery system are economically vulnerable. Insurance plans and providers scramble to adapt and survive in a rapidly evolving and highly competitive market; and the variations among health insurance plans—whether public or private—in eligibility, benefits, cost sharing, plan restrictions, reimbursement policies, and other attributes create confusion, inequity, and excessive administrative burdens for both providers of care and consumers.

Because of its history, structure, and particularly the highly competitive market in health services that has evolved since the collapse of health care reform efforts in the early 1990s, the health care delivery system often does not interact effectively with other components of the public health system described in this report, in particular, the governmental public health agencies. Health care’s structure and incentives are technology and procedure driven and do not support time for the inquiry and reflection, communication, and external relationship building typically needed for effective disease prevention and health promotion. State health departments often have legal authority to regulate the entry of providers and purchasers of health care into the market and to set insurance reimbursement rates for public and, less often, private providers and purchasers. They may control the ability of providers to acquire desired technology and perform complex, costly procedures that are important to the hospital but increase demands on state revenues. Finally, virtually all states have the legal responsibility to  Nursing Home and Acute Care Hospital Essay Paper

monitor the quality of health services provided in the public and private sectors. Many health care providers argue that such regulation adds to their costs, and high-profile problems can create additional tensions that impede collaboration between the state public health agency and the health care delivery system.

Furthermore, when the delivery of health care through the private sector falters, the responsibility for providing some level of basic health care services to the poor and other special populations falls to governmental public health agencies as one of their essential public health services, as discussed in Chapter 1. In many jurisdictions, this default is already occurring, consuming resources and impairing the ability of governmental public health agencies to perform other essential tasks.Nursing Home and Acute Care Hospital Essay Paper

Although this committee was not constituted to investigate or make recommendations regarding the serious economic and structural problems confronting the health care system in the United States, it concluded that it must examine certain issues having serious implications for the public health system’s effectiveness in promoting the nation’s health. Drawing heavily on the work of other IOM committees, this chapter examines the influence that health insurance exerts on access to health care and on the range of care available, as well as the shortcomings in the quality of services provided, some of the constraints on the capacity of the health care system to provide high-quality care, and the need for better collaboration within the public health system, especially among governmental public health agencies and the organizations in the personal health care delivery system.

ACCESS TO HEALTH CARE

Health care is not the only, or even the strongest, determinant of health, but it is very important. For most Americans, having health insurance— under a private plan or through a publicly financed program—is a threshold requirement for routine access to health care. “Health insurance coverage is associated with better health outcomes for adults. It is also associated with having a regular source of care and with greater and more appropriate use of health services. These factors, in turn, improve the likelihood of disease screening and early detection, the management of chronic illness, and the effective treatment of acute conditions,” IOM notes in a recent report (IOM, 2002a: 6).Nursing Home and Acute Care Hospital Essay Paper

Private insurance is predominantly purchased through employment-based groups and to a lesser extent through individual policies (Mills, 2002). Publicly funded insurance is provided primarily through seven government programs (see Table 5–1). Medicare provides coverage to 13.5 percent of the population, whereas Medicaid covers 11.2 percent of the population (Mills, 2002). Additionally, public funding supports directly

Patient Falls
Patient falls is one of the commonest events within the healthcare facilities that affect the safety of the patients. Preventing falls among patients requires various methods. Recognition, evaluation, and preventing of patient falls are great challenges for healthcare workers in providing a safe environment in any healthcare setting. Hospitals have come together to understand the contributing factors of falls, and to decrease their occurrence and resulting injuries or death. Risk of falls among patients is considered as a safety indicator in healthcare institutions due to this. Falls and related injuries have consistently been associated with the quality of nursing care and are included as a nursing-quality indicator monitored by the American Nurses Association, National Database of Nursing Quality Indicators and by the National Quality Forum. (NCBI)
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls Nursing Home and Acute Care Hospital Essay Paper
The design of health care facilities managed by many statutes and technical specifications. It also influenced by many less defined needs and burdens. A trend towards specialization has resulted in a growing number of health care types. Among them are hospitals, nursing homes, outpatient facilities, rehabilitation facilities, urgent care clinics, and various specialized outpatient facilities. Health care facility needs are emerging quickly, and the direction of that evolution difficult to forecast. There is a noticeable movement from hospital-based acute care to outpatient care, and approaching a holistic, preventative, and continuous care of health and wellness.
Health Care Facilities
Health care facilities handle ensuring quality of care in hospitals, nursing homes, and other kinds of health care facilities. The in-patient facility consists of hospitals and nursing homes that require admission for up to 24 hours. The outpatient facilities provide clinical, diagnostic testing, and therapeutic services (Riegelman & Kirkwood, 2014). Clinical services typically found in the physician’s office. An out-patient facility consists of an urgent care clinic, and it does not require staying overnight. A hospital facility consists of many departments, it can service patients in an emergency situation or admit patients that need further observation and care for a short period. The hospitals can perform day or emergency surgery and also provide out-patient services for clinic visits. The nursing homes are other facilities that can assist patients with daily activities. The nursing homes, mainly, for elderly or physically challenge people that needs assistance on an everyday basis for long-term care. Nursing Home and Acute Care Hospital Essay Paper
Healing Hospital: A Daring Paradigm The spirituality in a healing hospital starts with the Chief Executive Officer and spirals downward toward management, and then the frontline employees. Healing hospitals must have a form of culture that serves the community. This includes the building, its contents, the CEO, the managers, and caregivers. This is what leads to the care that entails the spiritual mixture that takes into account a person’s whole body, which includes the mind and spirit. Healing and spirituality should be at the forefront of each patient’s…show more content…
Patients are sometimes placed on medications that cause variations in their temperatures. Does the staffing limits allow for the staff to provide spiritual time for the nurse- patient load? Many nurses cite increased patient loads as a hindrance to providing spiritual care to their patients. (Healthcare staff). The benefits of creating a healing environment are improved patient satisfaction, Better patient outcomes, a decrease in employee turnover, increased scores from JACHO (Joint Commission on Accreditation of Hospital Organizations) and improved financial stability. One can also reap the benefit of working in an environment filled with a compassionate staff (Chapman, 2010). Without CEO support the iniative of a healing hospital would be impossible.
The aim of this paper is to explore, analyze, and solve two main issues at a hospital located in the United States. The hospital, the location, the employees, and anything that happens inside of the hospital is pure fabrication of the author, unless there is a citation. Any resemblance is purely coincidental (common expression). This particular hospital has two major issues that need prompt attention and resolution. The first issue is a high number of medication errors and the second issue is a high nurse to patient ratio. We need to analyze and determine if both issues are interrelated in some way and find out a solution to both issues. The search conducted to write this paper was online UCF library with keywords medication errors in hospitals, nurse workload, medication safety cases, nurse workload staffing and measurement. Sainte Marie Catholic Hospital is a 450 bed hospital. The hospital staffs 1,700 employees and the nurse to patient ratio is 1:8 across the board throughout this not-for-profit organization. The number of staffed physicians is unclear. However, there are a total of 100 affiliated physicians and surgeons. The hospital reports an annual operating revenue of $500 million dollars.Nursing Home and Acute Care Hospital Essay Paper
It is quite common to have a fear of hospitals, as many people do. Who wouldn’t when a crowd of doctors in blue scrubs is rushing down the hallway yelling, “Code red! The patient is going into cardiac arrest!” Or while walking past an ambulance drop off and seeing some person gushing blood, accompanied with a rolling bed and ambient beeping. I too happen to be one of these people with a fear of hospitals. It was okay, though, because I would never end up in one of them myself. Or so I thought. It all started last summer when I unexpectedly discovered a bump on my left side. Obviously, at first, I was terrified as the panic quickly set in while I thought about each possible worst case scenario. Within the next few days, I fled to my pediatrician to get it checked out. After several lengthy questions and examinations, she came to the conclusion that I should have nothing to worry about. Hearing this caused a wave of relief to come by, but it swiftly left when she reckoned that I still had to have an ultrasound done just to make sure. Soon after that, the next appointment finally came due. Once there, I sat anxiously in the waiting room until suddenly, my name was called and the ultrasound began.
There many facilities throughout the United States that can assist patients with in-patient and out-patient services. The in-patient facility consists of hospitals and nursing homes that require admission for up to 24 hours. The outpatient facilities provide clinical, diagnostic testing, and therapeutic services. Clinical services typically found in physician’s office. An out-patient facility consists of an urgent care clinic, and it does not require staying in the facility. A hospital facility consists of many departments, it can service patients in an emergency situation or admit patients that need further observation and care for a short period. The hospitals can perform day or emergency surgery and also provide out-patient services for clinic visits. The nursing homes are other facilities that can assist patients with daily activities. The nursing homes mainly, for elderly or physically challenge people that needs assistance on an everyday basis for long-term care. The prompt clinics are the newest facilities that accept outpatients for treatment and services. Immediate care is convenient and costs less than the hospitals the other two facilities.Nursing Home and Acute Care Hospital Essay Paper
Memorial Hospital (MH) is a 349-bed regional and referral center that is challenged by nearly 100% occupancy rate by its inpatient operating room patients. Surgical growth is expected to increase due to an increase in population and aging in its primary service area. This challenge is a major concern for the leadership of the hospital due to the significant outmigration of surgical cases and reports of poor patient satisfaction. Memorial Hospital has requested a team of staff members from their financial and planning offices to develop a strategic approach to expand their surgical capacity and to improve patient satisfaction. The draft proposal calls for a two-phase capital project intended to increase operating room capacity, address technology limitations, and improve patient satisfaction. The proposal has many key pieces of information pertaining to the successful completion of the project. It delivers a clear analysis of financial growth, analysis of both inpatient and outpatient surgery markets and a clear analysis on how each phase of the project will address the strategic priorities of the hospital. The medical staff of Memorial Hospital consists of 160 members.
In the article, The Case of the Unhealthy Hospital, written by Anthony R. Kovner, a through description of a struggling hospital, Blake Memorial Hospital, is given. This paper is a SWOT analysis, and addresses the strengths and weaknesses within the hospital, as well as opportunities and threats outside of the hospital and in the surrounding community. Although limited in abundance, there are specific strengths of Blake Memorial Hospital, such as their new CEO, Bruce Reid, and the strong community base and need for healthcare services. On the other hand, weaknesses within the hospital and clinics, such as poor quality of care and facilities, and a low rate of funding, contribute to the declining performance of the healthcare organization as a whole. Outside of the organization are potential opportunities to cut costs by potentially closing clinics, and as a result, better the quality of care give to patients with increased funding. There are also opportunities to create an emphasis on the neighborhood clinics, for the poorer areas of the city, and potentially increase the referrals to the hospital Nursing Home and Acute Care Hospital Essay Paper