Ethical Dilemmas For Clinical Placements - 2386 Words

Introduction Nurses are faced with ethical dilemmas or ethical distress every day, each situation being unique and requiring nurses to set aside their own values and beliefs in order to provide proper care for their patients (Ramos, Brehmer, Vargas, Trombetta, Silveira, Drago, 2015). Ethical dilemmas allow nurses to learn more about themselves and help shape their morals and values (Potter Perry, 2014). An ethical dilemma arises in a situation in which no solution seems completely satisfactory (Drumwright, 2012). The purpose of this paper is to give the reader a clear idea that how nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. According†¦show more content†¦I explained with what techniques I overcame to the moral distress situation and left with moral residue. Lastly, I concluded that what I learned from this ethical issue and how I would be able to apply the knowledge gained from this situation during my future practice. Discussion At the clinical site, being a student nurse, I witnessed issues such as a lack of respect for a patient, including inappropriate ways of speaking and behaving to the patient by nurses, and inadequate explanations by nurses to the patient. The nurse in charge displayed an uncaring attitude toward an independent, but cognitively impaired wandering patient with the use of inappropriate speech to this elderly patient. There was no respect and dignity for the patient in the nurse in charge behavior and words. Furthermore, I felt that the nurse was not following the values and responsibilities stated by the code of ethics such as providing safe, compassionate, competent, and ethical care, and preserving dignity regardless of the patient’s condition (Potter Perry, 2014). As a result, the patient did not receive satisfactory and consistent care. Moreover, ethical responsibilities of nurses mentioned in the Canadian Nurses Association (CNA, 2008) is, â€Å"Nurses engage in compassionate care through their speech and body language and through their efforts to understand and care about others’ health care needs† (p.

Tattoos - 1085 Words

Tattoos While the oldest known tattoo was on an iceman found on the Italian-Austrian border with carbon-dating showing the iceman to be 5,200 years old (Lineberry, 2007) for many years, here in America, tattoos were only popular with sailors, soldiers, Marines, bikers and occasionally the rebellious teenager. Why were tattoos only popular with these few? Social taboos looked down on those with tattoos. However, through tattoos a person can show self expression, be self creative, and be identified with a certain belief or interest through the art, design or message. It is for these simple reasons their popularity over the last twenty years has grown at an incredible rate, and people of all ages, sexes, ethnic groups, and social†¦show more content†¦Many find themselves talking to each other after noticing a certain familiar marker on each other’s arm. Bikers tend to get tattoos that deal with Harley Davidson, a particular biker organization, such as the Hellâ€⠄¢s Angels or the Christian Motorcycle Association, or one of the many other biker tattoos. Athletes will often get their school logo or their number tattooed on their body. Professional working people often get a tattoo of something to do with their profession. Religious tattoos are also becoming more popular as people feel more the need to identify themselves with a certain belief, and want others to know their beliefs. With the popularity of religious tattoos it isn’t unusual to see someone with a cross, crucifix, star-of-David, praying hands, rosary, or a picture of Jesus or the Virgin Mother tattooed on their body (Maloney-Hawkins, 2004). According to one article, more than a millennium after church authorities condemned tattooing as â€Å"a form of deviltry† that disfigures the body, evangelical youth are permanently altering their bodies with images of crosses, sacred hearts, and angels. For a small but growing subculture within Evangelical Christianity, r eligious tattooing is becoming an increasingly legitimate expression of individuality, identity, and faith (Tattoos as Evangelical Chic, 1998). Tattooing is not limited to only the young or middle aged. One tattoo artist stated that he had a grandmotherShow MoreRelatedTattoos : Tattoos And Tattoos887 Words   |  4 Pages The Need to Know About Tattoos Tattoos are not just putting ink into your skin there’s a lot more behind it. Such as the meaning of the tattoo, the origins of tattoos, how to care for a tattoo, where to get that tattoo, and the understanding that this decision to get a tattoo is permanent. There is a long timeline for tattoos that stretch back to early history, since the the meaning, method and understanding of tattoos have completely changed. Some of the first tattoos that were ever found on mummifiedRead MoreTattoo Taboo : Tattoos And Tattoos1411 Words   |  6 PagesFour: Argument 22 April 2017 Tattoo Taboo Tattoos have been around for centuries, and were once used to identify various tribes, indicate social status, or sometimes they were a rite of passage to adulthood. As time passed to a more modern world, people donning tattoos were assumed to be either convicts, gang members, rock musicians, or rebellions of society and most were deemed of unsavory character. Now, with over 45 million American adults having at least one tattoo, the taboos have all but disappearedRead MoreTattoos And The Tattoo Renaissance1554 Words   |  7 PagesWhen studying the history of tattoos, pinpointing the first time a tattoo was seen was almost impossible to do until 1991. An Iceman, named Otzi, was found by German hikers in 1991. Otzi was found covered with at least 57 tattoos (Huffington Post). This is to show that tattoos have been around for more than fifty-three hundred years. Otzi’s tattoos were discovered to be therapeutic and they consisted of lines and crosses all over the body. The next oldest tattoos were found on the Chinchorro mummyRead MoreTattoos And Body Of Tattoos Essay1577 Words   |  7 PagesTattoos and body pierced has been in our society for many years. Back then when tattoos was not a thing, many culture and religion used to inked their skin. In 1920s tattoos was common on prisoner, sailor, bikers, and that is why a huge part of of the population does not accept tattoos. Now, these days the art of tattoos is increasing, making a lot of money every year. These days people are getting more and more tattoos, making themselves addicted to it. Body art is used by people to express theirRead MoreTattoos And Its Effects On Tattoos946 Words   |  4 Pagesit came to opinions on tattoos; either people were adamantly for them, or people were adamantly against them. Controversy over tattoos has recently become more obsolete, the reason for this being that tattoos have become much more commonplace. They have basically become a fad; young adults find them to be a fashion statement. A completely neutral stance on tattoos is not universally taken, however: there are still those who are inclined against it. Although getting a tattoo can have consequences,Read MoreTattoo722 Words   |  3 PagesA: Ink tattoos. 1 Text 1: Andy Carringtons view of tattoos are made of a young adult position. Carrington, who have tattoos, think that the meaning of tattoos with the times have changed. Previously, a tattoo was something rare, but full significance. Nowadays it is something that categorizes the working class. Most have tattoos, either because it has symbolism Christian approach or simply because its beautiful. At the same time, he turns to whether it is because you want it or becauseRead MorePersuasive Essay On Tattoos And Tattoos869 Words   |  4 Pageswhere everyone finds out what is in style, to be like everyone else. Most people feel the need to follow others because of what they see in someone elses life such as tattoos and piercing. Just because someone has something that catches people’s attention it most likely doesn’t mean it will have the same result on you. Regarding tattoos and piercing, people need to be aware of infections, the holes they leave behind and the money invested in a change. The body design is always seen different by everyoneRead MoreThe Beginning of Tattoos695 Words   |  3 PagesWhen Did Tattoos Begin? Tattoos are not a new fad that grew over night. Tattooing has been a form of art that people have used to communicate with for ages. Whether it is a family crest, a butterfly, or a zodiac sign, all tattoos have meaning in which someone can tell a story. The history of tattoos goes as far back as the first people who roamed this Earth. Tattoos have been around for so long that no historian or archaeologist can precisely trace back to when and where tattooing began. From theRead MoreInk Tattoos855 Words   |  4 Pagesink tattoos presented in the texts. â€Å"When, for example, does tattooing become self-mutilation?† This quote is taken from text 1 by Andy Carrington who’s a poet and writer. In 2012 he published this text â€Å"Is Tattooing a Form of Self-Mutilation?† through his personal website. The question is: Does tattooing mean self-mutilation at all? It depends how you turn the perspective. Andy Carrington has a majority of tattoos, since he wrote â€Å"I will confess I chose to have a majority of my tattoos doneRead MoreThe Essence of Tattoos735 Words   |  3 PagesThe Essence of Tattoos Tattoos have likely been at the top of the list as the most discussed topic amongst the different social classes. There is a divide between societies understanding of tattoos, those who oppose them identify tattoos as being a form of â€Å"taboo† and is associated with a type of body modification that is seen as distasteful in nature. Others believe tattoos are a form of one’s own self-expression. Although tattoos are subjective to each person, we should not completely rule them

Taking a Look at Global Warming - 1368 Words

Global warming, or climate change, is a subject that is not going to show signs of cooling down any time soon. Why is it happening, what is causing it and how is it going to change our planet. Unfortunately, the earth is showing many signs of worldwide climate change, and based on the work of thousands of scientists in more than 130 countries, the prognosis is that humans have caused all or most of the planetary warming. Pollution, deforestation, and industrialization have significantly increased atmospheric concentrations of water vapor, carbon dioxide, nitrous oxide and methane; which are all greenhouse gases, and they trap heat near the earth’s surface. Humans are pouring carbon dioxide into the air faster than the planets and the ocean can absorb it. Historically, scientists studied climate and recognized that natural cycles in the earth’s orbit can alter the planets exposure to the sun, and warming and cooling cycles have occurred over hundreds and thousands of yea rs due to these shifts. These changes occurred over several centuries and the changes that are occurring now have been measured over the past hundred years or less. This has raised a global concern for the future of our planet because many species are facing extinction from disappearing habitats, changing ecosystems and acidifying oceans. Global warming is the process of gradual increase of average annual temperature of the Earths atmosphere and the great oceans. According to the United States EnvironmentalShow MoreRelatedTaking a Look at Global Warming754 Words   |  3 Pages Let’s first look at why global warming has even occurred. Energy technologies and civilization have developed side by side ever since the Lower Paleolithic era. For millenniums, humans have been searching for energy sources to fuel their lives. It was about one million years ago when humans first figured out how to control and use fire (Miller). Now, people rely on fossil fuels – mainly coal and oil – to supply our energy. What affect does coil and oil play on global warming? The combustionRead MoreTaking a Look at Global Warming1562 Words   |  6 PagesIs global warming being accelerated as a result of human interaction? This question has been asked over and over again since global warming was first noticed and b rought to our attention. Multiple claims have been made that this anomaly is caused by human interference with the planet. There are also those that strongly deny these accusations. To detect the truth, one must explore both sides of the story. Studies have been done by countless experts to support their side of the story; thereforeRead MoreTaking a Look at Global Warming794 Words   |  3 Pagesspoiling, and taking for granted the Earth that we are given. Some people think that the heating of Earth is natural and is inevitable no matter what mankind has to do with it. Whether man is affecting the warmth of earth, or if it is just a natural ongoing process is an open-ended and continuous argument. Because of its reoccurring and destructive circumstances the Greenhouse Effect has become a dilemma that is being researched and worked against amongst the world. Global Warming is caused by extremeRead MoreTaking a Look at Global Warming1373 Words   |  5 Pagescaused by global warming. Warming rate has accelerated over the past 30 years. The length and intensity of hurricanes and tropical storms has increased almost 100%, according to a MIT study. Between 1800 and 2000, the level of carbon dioxide increased by 31%. Scientists predicts that by the year 2050, 15-37% of all plant and animal species could be disappearing because of global warming. As a consequence considerable damages to our planet’s ecosystem are expected. Global warming is the increaseRead MoreTaking a Look at Global Warming1483 Words   |  6 Pagespeople, global warming just means that the Earth is getting warmer. What they don’t realize is that global warming is so much more than that. No matter how you call it, â€Å"global warming† or â€Å"climate disruption†, its effects are all the same. Rising sea levels, wildfires, droughts, and storms are all results of these rising temperatures. And if humans keep pumping large amounts of carbon dioxide into the atmosphere, these natural disasters will be just the first of many. To better understand global warmingRead MoreTaking a Look at Global Warming759 Words   |  3 Pagesand anthropogenic substances like green house gases that alter earth’s energy budget are drivers of climate change. Radiative forcing (RF) quantifies the change in energy fluxes caused by changes in these drivers and positive RF leads to surface warming. The largest contribution to total RF is caused by the increase in the atmospheric concentration of CO2 (1.68 W m-2) followed by CH4, Halo-carbons and N2O since 1750 (IPCC 2013). According to IPCC 2013 the CO2 concentrations will raise unprecedentedlyRead More Global Warming Essay example897 Words   |  4 Pagesperson reflects on the term global warming, they may perceive this term to relatively mean warmth that is taking place within our world. Warming that can possibly lead to potential threat to the environment and those amongst it. In exact terms global warming can be widely described as an increase in the temperature of the Earth’s atmosphere and surface area which contributes to the change of Earth’s climate, due to emissions of greenhouse gases. The fact that global warming has a significant role inRead MoreGlobal Warming Is A Real Issue That We Need To Start Taking1405 Words   |  6 PagesGlobal warming is a real issue that we need to start taking seriously. Our ancestors did an excellent job at maintaining the earth for us to come and enjoy but what are we doing? Are we preserving the earth for our future generation to come? First, let me give you a brief definition of global warming. According to whatsyourimpact.org, global warming is an average increase in the climate that contributes to changes in our global climate patterns. This is evident in the way our weather pattern hasRead MoreGlobal Warming Is A Real Phenomenon1048 Words   |  5 Pageshome ever since the origin of our species. We are constantly learning more about our planet. However, in the last century, there has been a different trend taking place. We have experienced a rise in the Earth’s temperature. Global warming is the phenomenon that has taken place over the past one hundred and thirty-three years. Global warming has been described as the greenhouse effect of dangerous gases released to the atmosphere. The gas eventually creates an invisible cloud over our planet whichRead MoreThe Threat Of Global Warming Essay1459 Words   |  6 Pages â€Å"When taking the heating of the entire climate system into account, our planet has warmed at a rate equivalent to 4 Hiroshima atomic bomb detonations per second over the past 15 years† (Cook). Our planet is becoming warmer. When scientists add up all the heat warming the land, oceans, atmosphere, ice melting, earth is accumulating heat equivalent to four Hiroshima bombs worth of heat per second. Global warming is a serious issue faced by our world as there has been a significant increase in temperature

Sonnet 18 and Sonnet 75 - 1457 Words

Amoretti : Sonnet 75 This poem is written in beginning modern English. Edmund Spenser uses some dutch words in his poem, like strand (now: beach). Here we have somebody who writes the name of the person he loves on the beach, because he wants the world to know hes in love. Its not clever because when the tide comes, the waves will wash it away. In poetry they use metaphor. An example : â€Å"you are like a red rose†, a red rose is a metaphor for beauty. Line 1-2: ‘’One day I wrote her name upon the strand, but came the waves and washed it away.’’ The speaker and his love are at the beach (strand) and the speaker is in a romantic mood, because he writes her name in the sand. The waves wash the name away. Line 3: â€Å"Again I†¦show more content†¦She is more beautiful and more temperate than a summer ´s day. Line 3: â€Å"Rough winds do shake the darling buds of May,† The darling buds symbolize the beginning of his love for her. The buds still have to develop into beautiful flowers, just like their love. It ´s the beginning of summer, her beauty and his love. The rough winds symbolize the rough start of their love. Line 4: â€Å"And summer ´s lease hath all too short a date:† He says summer is far too short, because in summer the flowers will bloom. If he compares her to a flower she ´ll bloom in summer and die after summer, as will her love. It doesn ´t last long enough for him. His love for her will continue and he doesn ´t want her to go. Line 5: â€Å"Sometimes too hot the eye of heaven shines,† The eye of heaven is the sun, which sometimes is too hot. Summer isn ´t steady like her art, like she is. Summer changes. â€Å"the eye of heaven† could also stand for God ´s eye which brings sunshine on earth. He watches over everybody, like the sunshine shines on everybody. With this metaphor he involves his religion in the poem. Line 6: â€Å"And often is his gold complexion dimmed:† The sun sometimes disappears behind the clouds, his gold complexion is dimmed by the clouds. His sunbeams aren ´t as strong as when there are no clouds. This could be a metaphor for their love. Their love isn ´t as strong as always, just like the sunbeams. Line 7: â€Å"And every fair from fair sometimesShow MoreRelatedSonnet 18 vs. Sonnet 75 Essay1079 Words   |  5 Pagesdemonstrate how poets reinforce my claim through their poems. Sonnet 75 by Edmund Spenser as well as sonnet 18 by William Shakespeare eternal lines (l.9) employs the theme of immortality. The poet tries to achieve immortality for his lover. In the sonnets, both personas state that their lover will be immortal So long lives this, and this gives life to thee (l.14). Both sonnets convey a message that even though the poet writes the sonnet the subject matter immortality is in the hands of externalRead More Immortality Through Verse in Shakespeare’s Sonnet 18 and Spenser’s Sonnet 751681 Words   |  7 PagesImmortality Through Verse in Shakespeare’s Sonnet 18 and Spenser’s Sonnet 75  Ã‚     Ã‚  Ã‚   Desiring fame, celebrity, and importance, people for centuries have yearned for the ultimately unattainable goal of immortality. Poets, too, have expressed desires in verse that their lovers remain as they are for eternity, in efforts of praise. Though Shakespeare’s Sonnet 18 and Spenser’s Sonnet 75 from Amoretti both offer lovers this immortality through verse, only Spenser pairs this immortality with respectRead MoreWilliam Shakespeare and Edmund Spenser771 Words   |  4 Pagesdifferent writing styles, as well as different topics that relate to each other in their own unique ways. In Shakespeare’s â€Å"Sonnet 18† and Spenser’s â€Å"Sonnet 75†, both poets speak of love in terms of feelings and actions by using different expressive views, allowing the similar topics to contain clear distinctions. Although Edmund Spenser’s â€Å"Sonnet 75† and William Shakespeare’s â€Å"Sonnet 18† relate in the sen se that love is genuine and everlasting, Spenser suggests love more optimistically, whereas ShakespeareRead MoreWilliam Shakespeare s Poetry Of Sonnets1693 Words   |  7 PagesOf Shakespeare’s collection of sonnets, a vast majority have been commonly established to be both written about and voiced to a beautiful, aristocratic young man often labeled the ‘Fair Youth’ — a seemingly polar opposite to the almost unsavoury, lower-class ‘Dark Lady’ assessed as the featured object of desire within the last 25 sonnets. Although some scholars such as Nelles (2009) neglect the prospect of two separate, distinct and truly gendered narratives, this concept must be considered in referenceRead MoreThe Movement Of The 18th And 17th Century Essay1526 Words   |  7 Pageswill look into the hallmarks of this period; Sonnets and their incredible movement into Europe. The essay will underscore that indeed poets are not solitary, hermetic personalities but ar e an expression of the communities. The prominent literary work in this period is an array of love traditions that had previously existed as independent practices in many centuries and across multiple nations and languages. William Shakespeare is the author of 154 Sonnets all of which form some of the most romanticRead MoreThe Treatment Of Outweighing By John Donne And Shakespeare On The Writing Of The Period2782 Words   |  12 Pages the voice of both present a scornful dismissal of the opposite sex in order to defy the typical conventions of heterosexuality. Whilst Donne explores lesbianism in his poem ‘Sappho to Philaenis’, Shakespeare reveals a hidden homosexuality in his sonnet sequence, exposed through the analysis of both his literature, and the changes made to the 1609 and 1640 published editions. Primarily, John Donne presents a disdainful dismissal of men in his narrative poem to demonstrate the sensual beauty and loveRead MoreWhat Are The Five Characteristics Of A Quest?1901 Words   |  8 Pagesand growing in strength by hurting someone else. 10.) Meaning behind â€Å"if its a square, its a sonnet† Sonnets have ten syllables and are 14 lines long, ten syllables in english is a long as 14 lines are high so a sonnet makes a square when in writing. 11.) How poets work magic on you? They use a certain choice in imaging, music in the language, content, and a play on words. 12.) Define Petrarchan sonnet First stanza has eight lines and the next has six, two separate rhyme schemes for the stanzasRead MoreAmerican Literature11652 Words   |  47 Pagesconceits that were witty, complex, intellectual, and often startling, e.g., John Donne s comparison of two souls with two bullets in â€Å"The Dissolution.† 17. conflict: a struggle between two opposing forces in a short story, novel, play, or narrative poem. 18. connotation: all the emotions and associations that a word or phrase may arouse; what a word suggests beyond its basic definitions; a word’s overtones of meaning. 19. consonance: repetition of consonant sounds in the middle or at the end of words Read MoreLiterature Marking Scheme9477 Words   |  38 PagesDuration 2 hours 15 minutes Assessed by the Centre; externally moderated by Cambridge Weighting 75% 25% OR Component Paper 1: Set Texts – Open books Paper 3: Unseen Duration 2 hours 15 minutes 1 hour 15 minutes Weighting 75% 25% OR Component Paper 4: Set Texts – Closed books: A Paper 5: Set Texts – Closed books: B Duration 2 hours 15 minutes 45 minutes Weighting 75% 25% The full range of grades (A*–G) is available in each option. Availability This syllabusRead MoreThe Tragedy Of Hamlet By William Shakespeare2594 Words   |  11 Pagesis about a character whose tragic flaw leads to his downfall and to the demise of many of the other characters. William Shakespeare was a playwright during the Elizabethan Era who was made famous for his literary works of tragedies, comedies and sonnets. One of Shakespeare?s most renowned tragedies is Hamlet. In this classic tragedy the protagonist, Hamlet, pursues revenge and seeks justice against the antagonist, Claudius, for the murder of King Hamlet. As a result of his pursuits, Hamlet, his family

Distraction Plate Fixation Post-Procedure free essay sample

Type III compression injuries o Require operative treatment if ? Intraarticular damage is significant ? Radial shortening is severe o Fixation with multiple Kirschner wires or plates is often necessary, and cancellous bone grafting is frequently required to fill impacted areas. Often a combination of open and closed techniques is necessary to satisfactorily treat type III fractures. Type IV avulsion fractures o Are usually associated with radiocarpal fracture-dislocations and are therefore unstable o Often the avulsed fracture fragments are so small that they can be repaired only with suture. o Secure reduction of the carpus to the distal radius can frequently be achieved only with Kirschner wires. Type V high-velocity fractures o Always unstable, frequently open, and difficult to treat o A combination of percutaneous pinning and external fixation is often necessary. Many of these fractures are so severely comminuted that open reduction is impossible. †¢ CONTRAINDICATIONS Severe medical comorbidities that prevent surgery EQUIPMENT †¢ †¢ †¢ Hand tray and hand table Small fragment and mini fragment set Technique-specific tray, as required ANATOMY †¢ The distal radius and ulna may be divided into three distinct columns. o The lateral and medial columns correspond to the scaphoid facet and lunate facets, respectively, of the distal radius. o The medial column is further divided into dorsomedial and volar medial parts. The ulnar column consists of the ulnar styloid and triangular fibrocartilage complex. ? ? Tears of the triangular fibrocartilage occur when the medial column of the distal radius, ulnar styloid, or both are intact. Distal radioulnar joint instability is associated with significant displacement of the ulnar styloid. TECHNIQUES †¢ †¢ †¢ Post-Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) Post-Procedure: Distraction Plate Fixation POST-PROCEDURE CARE †¢ †¢ †¢ †¢ †¢ Immediately begin finger and other joint upper extremity exercises. If a splint was applied, it should be removed at 3 weeks. Percutaneous Kirschner wires should be removed at 6 weeks. Activities of daily living are allowed, but lifting should be restricted to 5 lb. Once union is achieved, remove the distraction plate and begin range-of-motion exercises. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for distraction plate fixation. OUTCOMES AND EVIDENCE Ruch et al reported good to excellent outcomes in 90% of 22 patients using this technique. Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) POST-PROCEDURE CARE †¢ Immobilize the wrist and forearm with a plaster sugar tong splint for 2 weeks. †¢ †¢ Next, use a removable ball-peen splint, permitting gentle active exercises two or three times a day for the next 2 weeks. All immobilization is removed at 4 weeks and progressive motion continued until union is solid. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS The use of buttress plating for the treatment of distal radius fractures have proven to yield excellent results when surgical intervention occurs early and care is used to obtain anatomic reduction of the fracture. OUTCOMES AND EVIDENCE †¢ †¢ Smith et al: 100% union rate with 71% excellent, 18% good, and 11% fair results. Odumala et al: No difference in development of median nerve symptoms in patients treated with prophylactic carpal tunnel decompression compared with those without decompression. Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) POST-PROCEDURE CARE †¢ †¢ †¢ †¢ Keep the extremity elevated at all times until postoperative swelling subsides. Beginning on the first postoperative day, remove the splint 2 to 3 times a day for rangeof- motion exercises. Allow clerical work at 2 weeks. Resistive loading is allowed when signs of radiographic union appear. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for the Medoff system. OUTCOMES AND EVIDENCE Medoff reported 20 good to excellent results in 21 patients with intraarticular comminuted distal radial fractures treated with the TriMed Wrist Fixation System (TriMed, Valencia, Calif. ). Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) PRE-OPERATIVE AND POST OPERATIVE CARE Care of Pre-operative Patient Nursing Diagnosis Knowledge deficit R/T pre-op care. Expected Outcome Patient/parent will verbalize understanding of pre- post-op care. Nursing Intervention 1. Implement pre- post-op teaching program. 2. Document response. 1. Remove nail polish, make-up. 2. Bathe and shampoo the night before surgery. 3. Betadine scrub to surgical area. 4. Dress in hospital clothing after scrub. 1. NPO as ordered. 2. Sign at bedside; NPO sticker on patient. Potential aspiration R/T general No aspiration. anesthesia. 3. Re-emphasize importance of NPO to patient and parent; empty water pitcher and glass from bedside; check crib for bottles. 1. Explain procedures. 2. Provide time for patient/parent to ask questions, express fears or concerns. . Offer reassurance. Potential alteration of vital functions R/T surgery. Normal parameters for patients vital signs established. 1. Obtain baseline assessment of all systems N/V status within 8 hours pre-op. Potential infection R/T surgical procedure. Infection free post-op. Potential anxiety R/T surgery. Decreased anxiety. 2. Assess V. S. within 2 hours pre-op. Care of Post-operative Patient Nur sing Diagnosis Knowledge deficit R/T post-operative care. Expected Outcome Patient and family will verbalize and demonstrate understanding of postoperative care. Patient and family will cope effectively with surgical postoperative process. Nursing Intervention 1. Implement post-operative teaching program. 2. Document response. 1. Explain procedures. 2. Provide time for questions, expression of concerns and fears. 3. Offer reassurance. Potential anxiety R/T surgery, post-operative care. Potential respiratory Patient will not experience compromise R/T general respiratory compromise. anesthesia. 1. Assess breath sounds-HR/RR at least q shift. 2. Turn, cough and deep breathe q2 hrs. 3. Record vital signs. Patient will Alteration in comfort R/T verbalize/demonstrate relief surgery. rom pain. Potential neurovascular Patient will not experience compromise R/T surgical neurovascular compromise procedure. . 1. Assess for pain and medicate per protocol. 2. Reposition for comfort as ordered/prn. 1. Assess surgical site or affected extremity for color, capillary refill, sensation, temperature, pulses and active/passive ROM as ordered. 2. Document neurova scular status as ordered. 3. Report any neurovascular compromise to M. D. 4. Position extremity with elevation if ordered. 5. Apply ice or heat as ordered. Potential alteration in level of consciousness R/T anesthesia. Patient will exhibit appropriate LOC. 1. Assess LOC q shift. 1. Monitor I/O q hour with IV or foley. 2. Begin ice chips or clear liquids slowly as ordered. 3. Maintain IV fluids as ordered. 4. Call M. D. for catheter order if unable to void after surgery. 5. Assess GU status q shift. Potential alteration in bowel elimination R/T Patient will have BM by postanesthesia and postoperative day #4. operative immobilization Potential alteration in skin integrity R/T immobility. Patient will not experience skin breakdown. 1. Mobilize as ordered. 2. Administer laxative of choice or suppository for no BM after 3 days. . Assess GI status q shift. 1. Assess skin q shift. 2. Provide daily nursing care. Potential alteration in fluid balance R/T surgery. Patient will have adequate fluid intake and urine output. Medical Diagnoses: Impaired Physical Mobility, Acute pain, secondary to fractured left femur, ORIF surgery, Musculosketeal impairment Assessme Nursing Client Nursing *I Evaluation nt DX/Clin ical Goals/Desired Interventions/Actions/ Goals Interventio Problem Outcomes/Object Orders and Rationale ns ives Subjectiv Problem: Long Term: * Apply any ordered X Goal met. Continue e brace before Pt was intervention Impaired Pt will be able to mobilizing the client. able to s as listed. Pt Physical ambulate around ambulate Encourage screams Mobility the nurses’ Rationale: around pt to when station 2X by â€Å"Brace support and the continue the staff discharge. stablilize a body part, nurses’ use of attempts allowing increased station by braces and to move mobility. † (Ackley discharge. assistive the left Ladwig, 2008, p 552). Pt was devices lower able to after extremity *Increase complete discharge Pt demonstr ates difficulty with any movemen t of the left lower extremity . independence in ADLs Rationale: â€Å"Providing unnecessary assistance with transfers and activities may promote dependence and a loss of mobility. † (Ackley Ladwig, 2008, p 552). *Obtain any assistive devices needed for activity. Rationale: â€Å"Assistive devices can help increase mobility. † (Ackley Ladwig, 2008, p 552). R/T: Short Term: Obje ctive Pt states that his pain level is a 9 on a 10 point pain rating scale. is activity until he more than feels twice. Pt comfortable did not c/o. complain Encourage of any the pt to pain or continue his discomfort independen upon ce in ADLs ambulatio and c/o n. unnecessary assistance. Pt states â€Å"I feel like I’m finally getting back to my old self. † X Goal met. Pt able to fully complete passive range of motion exercises with assistance from the staff by the end of this shift. Pt did not complain of any pain associated with exercise session. Continue intervention s as listed. Continue to assess pain using the 10 point pain scale q4 hrs or PRN. Continue to provide pain control and treat as needed. *Assess the pt’s pain Acute Pt will perform by using the 10 point pain, passive range of pain rating scale q4 hrs secondary motion exercises or PRN. to by the end of this fractured shift. Rationale: left femur â€Å"Single- item ratings of Pt pain intensity are valid grimaces ORIF and reliable as during surgery measures of pain any kind intensity. of motion Anxiety or â€Å"The client’s report of movemen Musculosk pain is the single most t of his eteal reliable indicator of left lower impairmen pain. † extremity t (Ackley Ladwig, 2008, p. 604-605). AEB Pt’s ORIF *Before activity, treat Grimacing surgery pain. during movement Rationale: or activity â€Å"Pain limits mobility and is often Pt complaints about pain and discomfort Pt pain rating of 9 out of 10. Surgery that is 2 days postop exacerbated by movement. † (Ackley Ladwig, 2008, p 552).

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Question: 1. From a consulting perspective, propose the major steps that Caring Angel Hospital could take to achieve each of the following goals: a. Improve the quality of care b. Add value to the organization c. Improve employee morale d. Design an efficient organizational chart e. Create a strong team environment f. Create the hospital's competitive edge. Answer: Improve the quality of care: The improvement of the quality of care in the hospitals requires a promising strategy to improve the overall quality of care in the hospital. It involves a systemic approach in which implementation is planning is required to access the overall performance of quality care in the hospitals. It emphasizes continuous examination and upgrading of the processes of work. The most important thing to improve the quality involves the assigning of well-designed roles and responsibilities. Good support and cooperation are required by all the professionals of the hospitals to improve the quality of care (Bossen et al., 2016). Add value to the organization: To add value to the organization, Caring Angel Hospital requires some specific strategies to maximize value for the patients. The primary concern should be to achieve the best outcomes and satisfy the needs of the patients. A transformation is required to add value to the organization. The consideration of making money should not be the only concern. Indeed, they should provide enhanced services to the patients. A good quality of administration and philosophy is required to add value to the organization. c. Improve employee morale: An organization is held together with high morale. With this, the productivity of the organization is elevated, and the employees recommend novel ideas to help regarding increasing the efficiency of the organization. This can be achieved by creating the plans of giving incentives to the employees and taking feedback concerning the issues of the company (Nowicki, 2015). d. An efficient organizational chart: An efficient organizational chart comprises of the following elements: Leadership- To lead and guide the other individuals and team members. Decision making- Selection of belief among several other similar options. People- The professionals are working in the organization. Work processes and systems- To ensure the productivity of the staff and enable the tools of the working system. Culture- A system of living of an assembly of people. e. Create a strong environment team: A strong team environment is necessary for every organization to progress in all the aspects. A collaboration and co-operation are required between all the members of the team. Other characteristics such as strong leadership, creative concepts, development and the building of some unique strategies will help in building a strong team. This factor is very much essential for every organization to accomplish the goals (Myllrniemi et al., 2012) f. Create the hospitals competitive edge: The creation of the hospital's competitive edge requires the understanding of the reality of the new healthcare and analyzes the data of the hospital. They need to understand regarding their performance by comparing it with others. They need to identify ways to improve through personal opportunities. Competition exists among all the hospitals of the same place. Hence, the Caring Angel Hospital should understand the current scenario regarding the healthcare and should also focus on the weaker sections (Lucas et al., 2013). 2. The recommended strategy to acquire a larger market share, Caring Angel Hospital should concern the implementation of an ambulatory strategy. This strategy is concerned with the investment in the development of a robust ambulatory network. It includes everything, from the practices of primary care and urgent care centers to the ambulatory centers and other specialty oriented facilities. The hospital should facilitate an improved communication among the providers of the health care. They should produce complete health records that should be accurate because it is related to the life of the patients. A better tracking of the costs and benefits of the health care will help in understanding the money matters of the delivery of the health care. This strategy can also assist in the detection of a health care fraud. The healthcare providers need to know the need of investment of capital in the ambulatory network (Ulrich, 2013). While beginning the projects regarding the capital ambulatory, management of the hospital needs to decide either obtain or construct new facilities, and they should focus on the essential elements regarding the overall care of the patients. This strategy will benefit the hospital in understanding the targets of capital spending and the referrals of revenue. The need for maximizing the capital expenditures is not an easy task for any hospital but it should be considered as an important factor to acquire a large market share effectively (Bloom et al., 2015). 3. The two value-added services that Caring Angel Hospital could offer to strengthen its value proposition are: Dietary sources: The hospital should improve its dietary services. The patients who are vegetarians should always be given vegetarian food and the patients who are non-vegetarians should be provided with non-vegetarian food depending on the health status of the patients. The hospital should also construct a restaurant or cafeteria, where all types of food should be provided to the relatives of the patients, working with staff, doctors, etc. A perfect care regarding the quality o f food and dietary services should be of utmost concern because it is considered as an important factor in the recovery of the services along with the medicines and treatments (Dabholkar, 2015). Commercial Services: The hospital needs to focus on its commercial services such as Parking facilities, ATM, and banking services, Flower and fruit shops, Book and magazine shops, Cyber cafes, Communication facilities, postal services and, of course, a 24x7 pharmacy. The things account for the overall progress and the reputation of the hospital. These days people are so busy in their lives that they dont find time in carrying or buying these things while visiting the patients (Ahmad, 2013). The hospital needs to make sure that the healthcare is designed in the minds of the patient. The hospital also needs to involve the patients and the communities who are involved with the care. A hospital is always accountable for the all the concerns of a patient, whether it is a health related issue or financial issues. The hospital should become a center of attraction regarding the services it provides to the patients. These factors will provide a good experience in the hospitals while staying in the hospital and retaining the existing clients, hence elevating the growth of the hospital (Green, 2013). The people who are concerned with the management in the Healthcare are concerned with all the policies, accounting, and facilities. A health care manager needs to get experience and become specialized regarding the policies, accounting and facilities of the health care. He is also concerned with the overall operation of the facility and reports the daily activities to the higher authorities. The health care management system is utilized by the hospitals, doctors, and health maintenance organization involves a unit for processing and some guidelines for the health condition of the patients. The health care improvement is a phenomenon of global concern. Several countries are experiencing the same problems with the system of the health care. Many of them see management as a central entity, and the principal means to secure a reputed position in the hospital market. It aims to exercise and improve the overall healthcare in the hospitals. It emphasizes more on the practice of the professi onals of the health care by utilizing the resources (Kim, 2012). Therefore, the senior consultant at the Caring Angel Hospital should take into consideration all of the problems which the hospital is facing right now. He should expand the hospital market by involving these strategies in an efficient way because it is the need of the hour. References: Ahmad, S. (2013). 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Strategies for safeguarding security of mobile computing: hospitals can gain a competitive edge by responding strategically to the rapid proliferation of mobile devices in health care, with security being an intrinsic part of their strategy.Healthcare Financial Management,67(2), 88-93. Kim, T. H. (2012). Succession planning in hospitals and the association with organizational performance.Nursing Economics,30(1), 14. Lucas, J., Bulbul, T., Thabet, W. (2013). An object-oriented model to support healthcare facility information management.Automation in Construction,31, 281-291. Myllrniemi, J., Laihonen, H., Karppinen, H., Seppnen, K. (2012). Knowledge management practices in healthcare services.Measuring Business Excellence,16(4), 54-65. Nowicki, M. (2015).Introduction to the financial management of healthcare organizations. Health Administration Press. Ulrich, D. (2013).Human resource champions: The next agenda for adding value and delivering results. Harvard Business Press.