Measuring Patient Dependency in Clinical Settings

Measuring Patient Dependency in Clinical Settings Title: Should patient dependency be used to set nurse-staffing levels in general hospital wards? Introduction: In this section, we perform a literature review to discuss patient dependency in clinical settings, and examine how we can measure patient dependency levels. We also discuss whether patient dependency levels should and could form the criteria for setting nurse-staffing levels in the hospital. We will also analyze the other different methods and criteria that can help to determine nurse staffing levels within the clinical setting. Patient dependency levels indicates the requirements of nurses and the extent to which patients will need nurses for their continuous care. Nurse patient ratios are often used to discuss the nurse staffing levels and these figures indicate whether staffing levels have to be increased or decreased. We would aim our discussion of patient dependency necessitating increase in staffing levels and the patient nurse ratio as indicators of nurse staffing both within general hospital wards and at critical care and emergency units. Evidential Information Patient dependency may just form an important part of nursing staff and workload of an individual nurse. Hurst (2005) conducted an important study on the nature and value of dependency acuity quality (DAQ) demand side nursing workforce-planning methods, which are set in the context of nursing workforce planning and development. Extensive DAQ data was obtained from UK nursing workforce in 347 wards, which involved 64 high quality, and 62 low quality hospital wards. The study gives special consideration to workload and quality contexts. New insights have been generated with this study and Hurst emphasizes that poor quality care is more common in larger wards that have fluctuating and unstable workload and nurse – patient ratio. Smaller workloads having consistent and high workload of nursing staff results in inflexible nurse staffing so staff levels and performed duties remain the same. Studies definitely suggest that nursing activity and staffing differences do form an importan t part of defining and contributing to the quality of the wards with higher staffing levels and more consistent work for nurses at high quality wards and lower staffing levels and irregular services with low nurse-patient ratio in low quality wards. From this evidence, it is possible to provide recommendations for nursing management and practice and probe into more accurate relations of dependency acuity quality in DAQ measures. In a study using assessment of patient nurse dependency systems for determining nurse-patient ratio in the ICU and HDU, Adomat et al (2004) point out that a huge range of patient classification systems or tools are used in critical care units to inform workforce planning, and nursing workload although the application of these methods may not always be relevant, complete or appropriate. The systems or tools used for patient classification and categorization were developed solely for the purpose of more efficient distribution of patient across hospital sections, although now the same systems are used for workforce planning, distribution of workload, determining nurse-patient ratio in critical care settings. However these changes can raise a number of issues related to workforce planning, staffing levels and nursing management in general. Adomat and Hewison evaluate the three main assessment systems used in critical care units to effectively determine the necessary nurse-patient ratio t hat can provide the best quality service in the wards. The application of these tools is to enhance the quality of care by keeping nurse-patient ratio at its optimum. The authors suggest that decisions relating to workload planning and determining the nurse patient ratio are dependent on an understanding of the origins and purpose of the classificatory tools that categorizes patients and measures their dependency on care services. Patient dependency and classification systems as well as patient dependency scoring systems for severity of illness are measures indicating mortality and morbidity although Adomat points out that these dependency measure may not be real indicators or determinants of the nurse-patient ratio that help in measuring nursing input. The costs of providing a nursing service within critical care uses nursing intensity measures to give a framework for nursing management and patient care and also determines the exact role of patient dependency in nurse staffing leve ls. However, components of the nursing role and how it determines standards of care have not been fully determined (Adomat and Hewison, 2004). They point out that careful consideration of patient dependency and classification systems may be necessary to plan, organize and provide a cost effective critical care service. In a similar study, Adomat and Hicks (2003) evaluates the nursing workload in intensive care a there is a growing shortage of nurses in these care units. The problem identified in this shortage lies in the method for calculating the nurse/patient ratio using the Nurse Workload Patient Category scoring and classificatory system use in most intensive care units. The nurse-patient ratio is determined by using the patient category or dependency scales and the general assumption is that the more critically ill a patient is, the more care and nursing time will be required for the patient. Many critically ill patients placed on a high level of mechanical care such as a feeding or ventilator tube and in intensive units may however require less direct personal nursing care than patients who are self ventilating or have been considered to have lower levels of dependence. Thus patient dependence may be addressed by means other than direct nursing care and artificial care and support systems may b used instead of nursing staff. These and other factors show that patent dependency may not be a completely relevant measure for determining nurse –patient ratio or nurse staffing levels and many associate factors have to be considered. This study by Adomat and Hicks use a video recorder to document nurse activity in 48 continuous shifts within two intensive care units and helped to determine the accuracy of the Nursing Workload Patient Category scoring system to measure nurse workload. The data obtained from the video of nurse activity was then correlated with the Patient category scale score that was allocated to the patient by the nurse in charge. The results of this study showed that the nursing skills required in these care units were of low skill type despite the needs of care being complex in general. It was found that nurses spent less time with patients who were categorized as in need of intensive care than those in need and in high dependency range in all units. T he findings indicate that existing nurse patient ratio classifications are inappropriate as nurses spend less and less time with critically ill patients. The authors expose the flaws of classification or scaling systems that tend to correlate care with critical illness. They suggest that radical reconsideration of nursing levels and skills mix should make it possible to increase provisions and levels of intensive care providing the right numbers of staff at the appropriate units where patients need them most suggesting more flexible and alternative approaches to the use of nurse-patient ratios. In a similar study discussing relationship between workload, skill mix and staff supervision, Tibby et al (2004) proposes a systems approach and suggests that hospital adverse events or AE are more likely when sub-optimal working conditions occur. Proper working conditions are thus absolutely necessary to ensure the smooth working of the clinical setting. Tibby and colleagues analyzed the adverse events in a pediatric intensive care unit using a systems approach and observational study to investigate the association between the occurrence of these adverse events and latent risk factors including temporal workload, supervision issues, skills mix, nurse staffing and the interactions between established clinically related risk factors (Tibby et a, 2004). The data was collected form 730 nursing shifts and the analysis was done with logistic regression modeling. The rate of adverse events was 6 for every hundred patient days and the factors associated with increased AE including day shift , patient dependency, number of occupied beds, and simultaneous management related issues although these were considerably decreased with enhanced supervisory ability of the nurses. Decreased number of adverse events have been found to be related to the presence of a senior nurse in charge, high proportion of shifts handled by rostered, trained, permanent staff and the presence of junior doctors. Patient workload factors such as bed occupancy and the extent to which the patient needs help and nursing supervisory levels and level of staffing such as presence of a senior nurse have been found to be associated. This study sheds light on the factors increasing or decreasing adverse events and helps in identifying the issues closely related to the need of regulating and optimizing nurse staffing levels. As we have already suggested through a study by Adomat and Hicks, patients in high dependency units may require more frequent nursing care and higher nurse-patient ratios than critical care units where patients may be supported by artificial methods. According to a study by Garfield et al (2000) high dependency units are increasing in the hospitals and becoming more important as part of a hospital’s facilities. Although the optimum staffing ratio for patients is unknown for such units, the Department of Health and Intensive Care Society recommend a level of one nurse for every two patients. Garfield et al recorded Therapeutic Intervention Scoring System scores and Nurse Dependency Scores in high dependency units over 7 months. The results indicated a weak correlation between nurse dependency score and therapeutic intervention scoring system score. The authors argue that a nurse-patient ratio of 1:2 may be insufficient for the management of a high dependency unit and based on t heir findings recommends a nurse to patient ratio of 2:3. Balogh (1992) points out that the literature on audits of nursing care shows a strong relation between the quality of nursing care provided and nursing labour force and staffing issues. Balogh suggests that all assumptions for setting nurse staffing levels on the basis of variations in patient dependency are unscientific and there are moreover no opportunities to use personal judgment in decision-making within hospitals to determine nurse-patient ratios. Balogh points out that such methods for determining staffing levels as well as audit instruments are outdated and insufficient to optimize service levels. The paper highlights the need for greater flexibility, more decision making power, and a more significant role of nurses’ personal judgment in selection and management of appropriate nurse staffing levels in dependency and critical care units. Conclusion: In this review of literature on the exact role of patient dependency in determining nurse staffing levels, we began by suggesting that it is generally believed that the more critical condition a patient is in, the higher the requirements of direct care suggesting that nurse patient ratio should be high in critical care units. This assumption however has been refuted by studies which shows that such clear criteria may not be sufficient for nurse management and staffing level decisions and other factors have to be considered. These include artificial means of life support and other mechanical devices that minimizes the need for manual staffing and reduces a critical patient’s nursing needs. A related study suggested that high dependency units rather than critical care units should be provided with higher levels of staffing although many other factors such as supervisory levels of senior nurses, skills available and already established method of determining nurse patient ratios s eem to be crucial factors. Along with the approach taken by several authors we can also suggest that personal judgment of nurses on the care needed by patients rather than inflexible scaling or scoring systems should be used by hospitals to determine staffing levels, considering patient dependency levels as well. Bibliography Adomat R, Hicks C. Measuring nursing workload in intensive care: an observational study using closed circuit video cameras. J Adv Nurs. 2003 May;42(4):402-12. Adomat R, Hewison A. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. J Nurs Manag. 2004 Sep;12(5):299-308. Ruth Balogh Audits of nursing care in Britain: A review and a critique of approaches to validating them International Journal of Nursing Studies, Volume 29, Issue 2, May 1992, Pages 119-133 The importance of data in verifying nurse staffing requirements Intensive Care Nursing, Volume 4, Issue 1, March 1988, Pages 21-23 Lynne Callaway and Edward Major Curtis C. A system of measurement of patient dependency and nurse utilization. Aust Nurses J. 1977 Apr;6(10):36-8, 42. Donoghue J, Decker V, Mitten-Lewis S, Blay N. Critical care dependency tool: monitoring the changes. Aust Crit Care. 2001 May;14(2):56-63. Garfield M, Jeffrey R, Ridley S. An assessment of the staffing level required for a high-dependency unit. Anaesthesia. 2000 Feb;55(2):137-43. Hurst K. Relationships between patient dependency, nursing workload and quality. Int J Nurs Stud. 2005 Jan;42(1):75-84. Hearn CR, Hearn CJ. A study of patient dependency and nurse staffing in nursing homes for the elderly in three Australian states. Community Health Stud. 1986;10(3 Suppl):20s-34s. Miller A. Nurse/patient dependencyis it iatrogenic? J Adv Nurs. 1985 Jan;10(1):63-9. OBrien GJ. The intuitive method of patient dependency. Nurs Times. 1986 Jun 4-10;82(23):57-61. Prescott PA, Ryan JW, Soeken KL, Castorr AH, Thompson KO, Phillips CY. The Patient Intensity for Nursing Index: a validity assessment. Res Nurs Health. 1991 Jun;14(3):213-21. Seelye A. Hospital ward layout and nurse staffing. J Adv Nurs. 1982 May;7(3):195-201. Tibby SM, Correa-West J, Durward A, Ferguson L, Murdoch IA. Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision. Intensive Care Med. 2004 Jun;30(6):1160-6. Epub 2004 Apr 6. Williams A. Dependency scoring in palliative care. Nurs Stand. 1995 Oct 25-31;10(5):27-30. For scoring systems Depatment of health – www.dh.gov.uk

Personal Reward and Stimulation

Assessment task 4 : project 1 Ground rules for how a team will operate: Current level: We treat each other with respect. We intend to develop personal relationships to enhance trust and open communication. We value constructive feedback. We will avoid being defensive and give feedback in a constructive manner. We strive to recognize and celebrate individual and team accomplishments. As team members, we will pitch in to help where necessary to help solve problems and catch-up on behind schedule work Team member opinion: Team members can speak freely and in turn and all participants will have a sayNo one person will be allowed to dominate the discussion Team members will not speak on behalf of anyone else Team members will say what they think and not what they think someone else wants to hear Strengths and weaknesses Strengths: More friendliness, confiding in each other, and sharing personal problems; discussion of the team’s dynamics A sense of team cohesion, a common spirit an d goals Establishing and maintain team methods and boundaries Weaknesses: Arguing among members even when they agree on the real issues Defensiveness and competition; factions and â€Å"choosing sides†Establishing unrealistic goals Expressing concern about excessive work My Recommendations: Discuss team expectations Communicate; make sure everybody stay in the loop. Use organizational tools. 2 COMUNICATING RESPONSABILITIES. Current level By communicating responsabilities, you will be able to obtain desired results/outcomes, improve an employee's performance, and develop new skills. When you do meet to discuss these expectations, standards, and goals, meet in a quiet place without interruptions and have the job description and objectives in hand.Be sure to discuss the expectations with the employee and confirm that the employee understands the tasks and responsibilities of the position. Meet in a quiet place without interruptions 1. Have the employee's position description as well as unit's business plan and/or objectives at the meeting 2. Talk with employee about expectations, 3. Confirm that employee understands the tasks, responsibilities of the position 4. Ask the employee for comments, suggestions on performance standards 5. Finalize performance standards with employee, confirm the employee's understanding 6.Define performance standards at each level of performance, e. g. , meets expectations, exceeds expectations. Team member opinion Communication is one of the keys to running a successful business. And no one in a business should be exempt from workplace communication responsibilities. All employees and management of all companies no matter what size must learn proper business communications to insure excellence and productivity in the workplace Strengths and Weaknesses Strengths Skilled communicators recognize that effective communication takes forethought.For example, smart managers first evaluate their intended audience to gauge such factors as the current mood, audience education level and the context of the situation, and they frame their message accordingly. Effective communicators also evaluate all the possible channels available for communicating, such as face-to- face, over the phone and via email, and they choose the channel best suited for that particular message and audience. Also key to communicating effectively is learning to engage in actively listening: It takes two people — a sender and a receiver — to communicate.Effective communicators avoid distractions and focus on more than just the spoken word. They evaluate body language and tone of voice for clues to gauge whether their intended audience comprehends the message. Skilled communicators in the workplace also encourage open feedback, recognizing that communication is a constant process. Weaknesses: Typical weaknesses in communication include failure to adequately consider the needs of the audience. For example, rushed employees trying to me et deadlines often overload their audience with information, losing important details in the process.Additionally, many communicators inadequately evaluate their audience and ignore the impact of such crucial details as cultural background or education level on the communication process. For instance, industry experts who speak only in jargon will lose members of a general audience lacking experience with those terms. Ineffective communicators also underestimate the affect of physical distractions and emotional interference on their audience. Audiences often discount a speaker’s message if she uses bad grammar, appears sloppy or lacks enthusiasm for the topic.My Recommendation Smart business managers encourage communication strengths in the workplace by modeling superior communication skills with their own messages. Effective communicators educate themselves on the their employees’ individual frames of reference and adapt their messages accordingly. They recognize that meaning exists not in words, but in the people who use those words, and they use language that their audience will understand, avoiding slang, jargon or colloquial expressions.Most important, however, smart business managers actively listen to their audience, ask questions and encourage feedback to ensure that both the intended information and meaning of a message are understood. 3 Share tasks and activities Current level A Task is an activity that needs to be accomplished within a defined period of time or by a deadline. A task can be broken down into assignments which should also have a defined start and end date or a deadline for completion. One or more assignments on a task puts the task under execution.Completion of all assignments on a specific task normally renders the task completed. Tasks can be linked together to create dependencies. Strengths and weaknesses Strength Leaders communicate where they want to take their companies. They also organize groups for particular task s and ensure that group members have a clear understanding of their individual roles. The task- oriented is well suited to structured work environments, such as law enforcement and manufacturing assembly lines, in which repeating well-defined processes usually results in consistently high levels of productivity and quality.Weaknesses In most projects, tasks may suffer one of two major drawbacks: Task dependency: Which is normal as most tasks rely on others to get done. However, this can lead to the stagnation of a project when many tasks cannot get started unless others are finished. Unclear understanding of the term complete: For example, if a task is 90% complete, does this mean that it will take only 1/9 of the time already spent on this task to finish it? Although this is mathematically sound, it is rarely the case when it comes to practice 4 Planing and schedule activities Current level

History Paper

According to Pane’s account, what part did caves play in human origins? 1b. What happpened to Machochael and the men who left the cave to go fishing? If when they went out at night and was not able to return befiore the sun rose, upon seeing the light, as punishment since they were not allowed to see it, were immediately transformed into those trees that yeild plums. These grow spontaneously on that island in great quantity, without being planted. 1c. How did their acts alter the world? 1d. Why did the Taino go on pilgrimages to Iovanaboina? 1e. Why were zemis important? 2a.Pane says the Taino told him that men left the caves â€Å"without their women,† How did women come to populate the earth? 2b. Does the narrative suggest that men and women were created more or less as equals? 3a. This Taino origin story emphasizes that humann beings were â€Å"transformed† in numerous ways to shape the world. Why did these transformations occur, according to the narrative? 3b . How did theese transformations influence humans who were not transformed? 4a. In what ways is Pane’s religion evident in his account of Taino origins? 4b. Do you think Pane was a reliable recorder of Taino beliefs? c. What parts of Pane’s account, if any, seem credible to you? Why? 5a. Since Tainos † never had writing among them and everything is preserved by memory,† do you thing the stories the Taino told Pnae were credible accounts of ancient beliefs?5b. What evidence suggests that Taino believed these stories? 5c. Is there evidence that their origin narrative had ancient roots? 5d. On the other hand, is there evidence that they might have invented the narrative to please or satisfy Pane? 1a. According to this narrative how did human beings arrive in the world? b. What was the significance of the â€Å"great tree which every year bore corn used for food† and of the angry young men? 2a. Who does the narrative say created the earth, and why? 2b. W hat relationship existen between animals and the earth? 3. According to the narrative, how did human beings reproduce? Why? 4a. How did Othagwenda (Flint) and Djuskaha (Little Sprout) differ? 4b . Why were those differences important? 5a. Who does the narrative identify as God? 5b. What difference did it make? 1. According to Genesis, how and why did God create the world? 2.Were plants, animals, and human beings in this account more or less equal in God's eyes? No they were not equal. God said have dominion over the fosh of the sea, and over the fowl of the air, and over ever living thing that moveth upon the earth. 3. Why did God command human beings to â€Å"Be fruiful, and multiply, and replenish the earth, and subdue it: and have dominion†¦ over every living thing that moveth upon the earth†? 4. Did God make different demands on men and women? Why? 5a. Why did God forbid Adam and Eve to eat from the tree of the knowledge of good and evil? 5b.Why did they disobey God? 5c. How did God punished them? 6. How might the Genesis account of human origins have influenced Europeans as they encountered peoples in Africa and the New World? 1a. According to Aristotle, why were some people â€Å"natural slaves†? 1b. Who were these people? 1c. Why was slavery for them natural? 1d. Why was slavery â€Å"beneficial and just† for them? 2a. How would you argue against Aristotle's defense of natural slavery? 2b. Did he make false assumptions? 2c. Were his arguments illogical? 2d. Can you argue against his view starting from his assumptions? How? 3a.To what extent did Aristotle believe that it was good and just for vitors in war to enslave their captives? 3b. Was slavery for Aristotle anything other than the superior power of the master over the slave? 3c. What arguments did Aristotle make against the claim that â€Å"all slavery is contrary to nature†? 3d. Do you find his arguments convinving? Why or Why not? 4a. How did the relation of master to slave differ from that of man to woman, husband to wife, parent to children, and statesman to citizens, according to Aristotle? 4b. In what sense were â€Å"all housholds†¦ monarchically governed†? c. Since Aristotle argued that â€Å"the relation of male to female is naturally that of the superior to the inferior, of the ruling to the ruled,† would he claim that women were natural slaves? 1a. What are the major differences and similarities among these creation myths? 1b. How do their views of human beings compare to Aristotle's? 2a. The creation narratives descibe a world before humans existed. To what extent were humans a force for good in the world? 2b. How did humans' power compare to that of nature of zemis or the creator? 2c. Did Aristotle's views differ? If so, how and why? 3a.How do the views of women and men in the creation my ths compare to Aristotle's views? 3b. What do they reveal about gender roles and expectations among Native Americans and Europ eans? 4. Because the creation narratives and Aristotle's Politics originated in oral rather than written communication, to what extent can these documents be accepted as expressions of the views of common folk among the Taino, the Seneca, and Christians? 5. To what extent might the creation myths and Aristotle's views about masters and slaves have influenced the begavior of Native Americans and Europeans when they encountered one another?

Spencer Hogue. February 27, 2017. Instructor Mrs. Nutter.

Spencer Hogue February 27, 2017 Instructor: Mrs. Nutter English 121 The War on Terror Through the Lens of Guantanamo Bay You wake up in a dimly-lit room laying down, your back flat on a cold table, facing unfamiliar men standing over you. You attempt to move, but your arms and legs are strapped down leaving you completely defenseless. Panicking, you begin to scream, but your screams are cut short as a wet cloth is laid over your face. You feel water being poured over the cloth and you begin choking; you can’t breathe; you are drowning. You are being waterboarded. What you just experienced was one of many common interrogation techniques used to pry information from suspected terrorists at Guantanamo Bay naval base. These techniques,†¦show more content†¦Our nation’s actions toward seeking justice and preventing any attacks of this scale from happening again came with quick notion, â€Å"Less than a week later (following the 9/11 attacks), Congress authorized the President to use military force ‘against those nations, organizations or persons he determines planned, authorized, committed, or aided the terrorist attacks,† (Yin). In essence, Congress gave the president the ability to use the military to seek out and detain terrorists responsible for 9/11, showing our country’s dedication to ending these attacks and those who initiated them for good. Overall, this tragic event revealed the need for stricter defense regulations against non-state actors (terrorists). For this reason, 9/11 was the catalyst for the beginning of the War on Terror and, consequently, the opening of Guantanamo Bay. Following the 9/11 attacks and the Congressional statement giving President Bush the power to seek out and detain terrorists, the Bush Administration asserted the need for an area of detention for these non-state actors. Certain criteria, however, had to be met to satisfy the administration and overall public safety of American citizens. These criteria include a desolate location out of U.S. Ter ritory as to prevent detainee escapes and allow loopholes in treatment of detainees and length of detention. On the Guantanamo Bay U.S. Naval Base, these criteria were fully met: it is surrounded by water, as to prevent