Sunday, January 26, 2020

Elderly Care: Proposal on Hospital Admittance and Discharge

Elderly Care: Proposal on Hospital Admittance and Discharge A proposal of change to improve the quality of care for vulnerable older people who after being admitted into hospital and on discharge do not have a lot of choice in services that they receive. They are either sent home with a care package which does not meet all needs of the older person or moved to a residential home. It has been said that independence and mobility are the two most precious commodities that the elderly, as a group, need to nurture as a significant decline in either will significantly increase their dependence and reliance on others, either in the family or in the community. (Whitely, S. et al 1996) In general terms, the plight of the elderly in hospital is probably the most precarious of all of the age ranges, irrespective of the illness for which they were admitted. Any form of debilitating pathology, even if it only puts them in bed for a few days, may very well weaken their already tenuous grip on independence. The result may be either a prolonged stay in a hospital bed, home discharge with a care package which may not be totally satisfactory and all too often dependent on the ministrations of a group of overstretched healthcare professionals, or discharge to some form of residential care – which, although possibly seen by some as being the best option for the debilitated or infirm elderly, has an enormous impact on both the independence and the lifestyle of the elderly person. Let us briefly consider this last option which is not as straight forward an option as may appear at first sight. Let us personalise the discussion by referring to a hypothetically representative Mrs J., a 78 yr. old lady who has lived alone since her husband died some ten years previously. She is fiercely independent but has been getting progressively more frail as the years have gone by to the extent that it is a struggle to get her shopping. As a result her diet is becoming progressively more inadequate. Her personal hygiene, which was meticulous a few years ago, is now also failing, and she spends a great deal of her time alone and in bed. She has developed a low grade chest infection which required her to spend three days in hospital. When it came time to discharge her, her daughter could not look after her and took the decision that she would be better in a residential home. Mrs.J. had virtually no choice in the matter and on the fourth day she found herself in a residential home, surrounded by people with an average age rather greater than hers, many of whom were suffering from varying degrees of dementia. The home had a completely imposed and inflexible regime which was a major imposition on her as she had previously been able to do what she wanted when she wanted. There was virtually no privacy and never a time, day or night, when there was silence or quiet. Her house had to be sold to pay the fees, so she knew that there was no possibility that she would ever go home again and any money that she had, she was not able to spend as her savings were also taken to pay the fees. In the space of four days her life had been overturned and although she was warm, fed and cared for, by any rationalisation her quality of life had changed for ever. Mrs.J. is quoted as being fairly typical of many and her case used to illustrate the enormity of the life changing impact of admission to a residential home. Critically examination the need for the proposed change The particular change that we shall highlight in this particular essay is the need for multidisciplinary discharge planning, a move which is highlighted in the National Service Framework for the elderly (Standard Two). As we shall discuss later in this essay, the National Service Frameworks have been conceived and drafted in response to the perceived need for change. It therefore follows that it is a self-serving argument that it is a recognition of a need for change in this area that has prompted its inclusion in the National Service Framework .This rather tautological argument is given credence by a number of studies that have both looked at, and demonstrated the need for change in this area. The paper by Richards (et al 1998) was a first rate examination of the problem. It covered a number of areas, but, with specific relevance to our considerations here it highlighted how the patient outcome could be improved by a timely multidisciplinary pre-discharge assessment by a team which included social workers. This paper, if nothing else, underlines the need for change and provides a model for how improvements in the multidisciplinary discharge function can produce potential benefits for patients Evidence to support this view can be found in anyone of a number of recently published papers (such as Ham C 2004) which has specifically surveyed patient and carer satisfaction levels in the area of welfare and associated services after hospital discharge for the elderly. An outline and critical discussion of how change can be implemented Change can be a trophic factor in any organisation but no matter how good the intentions and aspirations, if it is badly managed, then the end result can be a catastrophic mess. One only has to consider the debacle of the implementation of the Griffiths Report (Griffiths Report 1983) in the NHS in the 80s to appreciate how a major management change could be badly implemented. The Government even set up its own commission to see what lessons could be learned from the episode. (Davidmann 1988) If we consider the overall implications of the report in terms of change management, the innovations failed because they were imposed rather than managed. (Davidmann 1988) Another fundamental concept in the field of change management is expressed by Marinker (1997) who points to the rather subtle difference between compliance and concordance. He suggests that human beings generally respond better to suggestion, reason and coercion rather than direct imposition of arbitrary change. The management of change is perhaps the most critical of the elements in this discussion. There is little point in having vision or ideas if you cannot successfully implement them into reality (Bennis et al 1999). The whole study of the Management of Change is built upon a set of constructs known as the General Systems Theory (GST). (Newell et al 1992). The process is both general and adaptable and can be summarised in the phrase â€Å"Unfreezing, Changing and Refreezing† or in simple terms, assessing a situation changing it, and then making the changes stick. (Thompson 1992). All changes, but particularly health and welfare related ones, should only really be made after careful consideration of the evidence base underpinning that change (Berwick D 2005). In specific terms one should evaluate the need for implementation of a multidisciplinary discharge procedure by considering the evidence that the current situation could be improved, make managers aware of the findings of need and than be proactive in encouragement in terms of support of any decisions that are made to implement such moves. The Political context If one considers the pre-2000 structure and organisation of the NHS, one could come to the conclusion that there were three major problems which, some observers stated were not consistent with what was required of a 21st century care provider, namely: a lack of national standards old-fashioned demarcations between staff and barriers between services a lack of clear incentives and levers to improve performance over-centralisation and disempowered patients. (Nickols 2004) There have been a number of reforms in the NHS which potentially impinge on the cases of the dependent elderly. Arguably the most important was the NHS Plan (DOH 2000). This is a lengthy document which calls for some fundamental changes in the working practices, and in some cases the actual roles of a number of healthcare professionals. An analytical assessment would have to conclude that, although there is a lot of detail in some areas of the plan, there is actually comparatively little detail in just how these changes should be actioned and arguably even less detail in what it expected the changes to be (Krogstad et al 2002). In the context of our discussion here, we should also note the natural ideological successor to the NHS Plan, was the Agenda for Change (2004). The National Service Frameworks were then introduced after seminal guidance from the National Institute for Clinical Excellence (NICE 2004) The other reforms that have a bearing on our considerations are Choosing Health: making healthier choices easier (2004) and Building on the Best (2003). Both of these have considerable implications for the care of the elderly. The Choosing Health paper outlines the Government proposals for giving patients greater choice in the implementation of their health care and Building on the Best examines ways of improving and modifying current practices. There are specific references to the discharge procedures which are relevant to our discussions here. The Health context In the context of this essay the NHS Plan called for a number of reforms including: Increase funding and reform Aim to redress geographical inequalities, Improve service standards, Extend patient choice. Each of these areas has a bearing our Mrs.J. The geographical inequalities were primarily due to the historical context in which each area had implemented their own services together with the balance between funding and demand in each area. The improvement in service standards is mainly driven by the National Service Frameworks and he extension of patient choice clearly has a bearing on Mrs.J. although the choices available may well be less in practical terms than the complete spectrum of what is actually available and may well be constrained by factors such as available funding and the patient’s own physical state. (Wierzbicki et al 2001) The National Service Frameworks (amongst other things) sets out to reduce inequalities in service provision between providers and also to set standards of excellence, together with goals and targets that are nationally based rather than locality based. (Rouse et al 2001). National Service Framework Standard Two has as its stated aim to: Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries. It is formulated within the concept of â€Å"Person Centred Care†. This is intended to allow the elderly (and their carers) to feel entitled to be treated as individuals, and to allow them to be responsible for their own choices about their own care. The Social Care context If we accept that a patient’s discharge from hospital is dependent on many disparate and variable factors including (apart from their obvious health considerations), for example, their financial, dependence and support network status. It therefore follows that before a considered decision can be made to discharge the patient, a full and careful assessment of these various aspects should ideally be made. (Gould et al. 1995). The input of the social worker to the multidisciplinary pre-discharge team is therefore vital in this respect as it is unlikely that other healthcare professionals will be in a position to make an assessment of all of these factors. If one reads contemporary peer reviewed literature on the subject, the term â€Å"seamless interface† is a concept that frequently appears. (Dixon et al 2003). This reflects the moves towards the dismantling of the â€Å"Empire† concept of each health and welfare related subspecialty. (Lee et al 2004). And the positive integration of each, for the overall benefit of the patient. Central to this process is the advent of the Single Assessment Process (SAP) which is arguably the most important new work practice to facilitate good multidisciplinary working practices. This reduces the duplication of work, derivation of facts and paperwork that hitherto was commonplace (Fatchett A. 1998). In specific consideration of our Mrs.J. we could find that she was visited by one member of the discharge team (typically the social worker), and an assessment of all of the factors that we have discussed could be made and recorded in a single central document or reference point (computer). It is the stated aim of the SAP that the needs and wishes of the elderly patient will remain at the heart of the whole process. (Mannion R et al 2005) To consider the requirements of the National Service Frameworks and in the context of social work we should also mention the concept of the carer’s or patient’s â€Å"Champion† that has been specifically encouraged. (Bartley M. 2004). These are designated workers (often specially trained or experienced social workers), who would stand up for the need of the patient or their carers. In Mrs.J.’s case we could postulate that such a champion could assess her needs as being more appropriately dealt with by an intensive course of both physiotherapy and an occupational therapy input rather than necessarily being arbitrarily placed in a residential home. The social worker is ideally placed to assess and indeed to action interventions such as that of the occupational therapist, who can be shown to produce considerable impact on the ability of the infirm elderly to remain at home. (Gilbertson et al 2000). We should not leave this area without a demonstration that the evidence base in this area of social worker input as being both positive and beneficial by quoting the Logan paper (et al 1997) References Agenda for Change, 23 November 2004,  Government White Paper:  HMSO 2004 Bartley M. (2004),  Health Inequality. An Introduction to Theories, Concepts and Methods.  Cambridge: University Press 2004 Bennis, Benne Chin (Eds.) 1999,  The Planning of Change (2nd Edition).. Holt, Rinehart and Winston, New York: 1999. Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Building on the best 2003,  Department of Health:  HMSO: London 09/12/2003 Choosing Health: making healthier choices easier 2004 Government White Paper,  HMSO: London 16.11.2004 Davidmann 1988,  Reorganising the National Health Service: An Evaluation of the Griffiths Report,  HMSO : London 1988 Dixon, Holland, and Mays 2003 Primary care: core values Developing primary care: gatekeeping, commissioning, and managed care BMJ, Jul 2003; 317: 125 128. DOH 2000,  NHS Plan,  HMSO; London 2000 Fatchett A. (1998),  Nursing in the new NHS: Modern, Dependable.  London: Bailliere Tindall Gilbertson, Peter Langhorne, Andrew Walker, Ann Allen, and Gordon D Murray 2000 Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial BMJ, Mar 2000; 320: 603 606 ; doi:10.1136/bmj.320.7235.603 Gould MM, Iliffe S. 1995,  Hospital at home: a case study in service development.  Br J Health Care Manage 1995; 1: 809-812. Griffiths Report 1983 NHS Management Inquiry Report DHSS, 1983 Oct 25 Ham C. (2004),  Health Policy in Britain [5th ed.]  Basingstoke: Palgrave Macmillan Krogstad, Dag Hofoss, and Per Hjortdahl 2002 Continuity of hospital care: beyond the question of personal contact BMJ, Jan 2002; 324: 36 38. Lee, Wong, Yeung Wong, and Tsang 2004 Interfacing between primary and secondary care is needed BMJ, Aug 2004; 329: 403. Logan PA, Gladman JRF, Lincoln NB. 1997,  A randomised controlled trial of enhanced social service occupational therapy for stroke patients.  Clin Rehab 1997; 11: 107-113 Mannion R, Davies H, Marshall M (2005) Cultures for Performance in Health Care. Maidenhead: Open University Press Marinker M.1997,  From compliance to concordance: achieving shared goals,  BMJ 1997;314:747–8. Newell Simon. 1992,  Human Problem Solving.  Prentice-Hall, Englewood Cliffs: 1992. NICE 2004,  Management guidelines : NHS Directive;  HMSO, Tuesday 7 December 2004 Nickols F 2004,  Change Management 101: A Primer,  London : Macmillian 2004 Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow 1998 Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ, Jun 1998; 316: 1796 – 1801 Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001; 323: 1429. Thompson 1992,  Organisations in Action.  McGraw-Hill, New York: 1992. Whitely,S. et al (1996)  Health and Social Care Management,  Basingstoke: Macmillan. Wierzbicki and Reynolds 2001 National service frameworks financial implications are huge BMJ, Sep 2001; 321: 705. ############################################################# PDG

Friday, January 17, 2020

A small family Essay

There is an increasing trend around the world to have a small family rather than a large family. What are some of the advantages and disadvantages of having a small family rather than a large family? Over the past decades birth rates have steadily declined. Consequently, the says of nuclear families have diminish all over the world. This easy I will discuss the advantages and shortcomings of smaller family sizes. As small family can benefit children and parents and make it easier to find sufficient resources for a family. Children can enjoy their parents full attention instead of sharing it with multiple siblings. Additionally, I an family with less children sibling rivalry is less likely to be a problem among children. Parents can spend more time with the individual child and the child‘s favourite activities. Caring for a large family can be stressful mad exhausting. Parents of a small family should therefore be more relaxed and patient. Lastly, fewer children mean the family budget is more likely to leave room for some extras, like holidays or separate bedrooms for each child. On the other hand, there are also some downsides for all family members of a small family. Children can end become spoilt and less responsible than their peer growing in large families. Being an only child is often associated with egoism and less developed social skills. Parents will focus all their expectations on fewer children. This will heighten pressure to succeed on the individual child. Moreover, it might be simpler for parents to raise multiple children as siblings learn from each other and play together. In a large family every member can contribute is domestic duties are shared. Also, some common family activities, such as outdoor games, are probably more fun with a larger family. All in all, there are positive and negative aspects of having a smaller family. As family sizes are decreasing most people to believe the advantages outweigh the disadvantages significantly.

Thursday, January 9, 2020

Find Vocational and Trade Degree Programs 2019

The field of computer programming and networking is one of the areas where online certification programs via online vocational classes has worked well. There are certified distance learning courses in computerized graphic arts; PC repair; and civil engineering technology. There are also more specialized online training programs for established computer technicians in areas such as C++ programming and Visual Basic programming. With a concentration in graphics, you can learn how to draft with AutoCAD or learn all about desktop publishing via an online school. These types of skills that involve visual presentations work especially well in the distance learning environment because the computer and internet allow you to send your school work immediately to the instructor. Online schools have become a huge phenomenon. Vocational training has replaced an expensive college education for many young Americans. Enrollment in technical education soared by 57 percent from 9.6 million students in 1999 to 15.1 million in 2017, according to theU.S. Department of Education. .uc29b61e29fffad5345eef15bae8fbe24 { padding:0px; margin: 0; padding-top:1em!important; padding-bottom:1em!important; width:100%; display: block; font-weight:bold; background-color:#eaeaea; border:0!important; border-left:4px solid #34495E!important; box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -moz-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -o-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -webkit-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); text-decoration:none; } .uc29b61e29fffad5345eef15bae8fbe24:active, .uc29b61e29fffad5345eef15bae8fbe24:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; text-decoration:none; } .uc29b61e29fffad5345eef15bae8fbe24 { transition: background-color 250ms; webkit-transition: background-color 250ms; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; } .uc29b61e29fffad5345eef15bae8fbe24 .ctaText { font-weight:bold; color:inherit; text-decoration:none; font-size: 16px; } .uc29b61e29fffad5345eef15bae8fbe24 .post Title { color:#000000; text-decoration: underline!important; font-size: 16px; } .uc29b61e29fffad5345eef15bae8fbe24:hover .postTitle { text-decoration: underline!important; } READ Human Resource Management JobsSearch our index of Vocational and Trade Degree Programs offered by Accredited Colleges, Universities and Schools. Related ArticlesFind Vocational and Trade Online Degree ProgramsOnline Computer Science Courses Offer Multiple SpecialtiesEducational Requirements for Post-Secodary TeachingTechnology Universities and CollegesEarning a Masters Degrees in Computer Science OnlineOnline Computer Science Degree Important Contributions to Society from Professionals in Computer Science

Wednesday, January 1, 2020

Character Uses In Alice Walkers Everyday Use - 1095 Words

The short story â€Å"Everyday Use† by Alice Walker begins with the narrator, Mama, and her daughter, Maggie, sitting in the yard that they both prepared and cleaned the day before. They were waiting for Dee, the oldest daughter, that is returning from college in Augusta after seven years of education. Maggie is going to be nervous for as long as Dee stays because of the scars and burns marks she got from the fire in their previous house. Maggie thinks that Dee has a much easier life than her. Mama compared Maggie to a lame animal and Mama thinks Dee is lighter than Maggie. Also, Mama believed that Dee hated Maggie, but that was before Mama and the community church raised the money to send Dee to school in Augusta. When Dee showed up†¦show more content†¦Dee becomes infuriated and says that Maggie would wear them out in less than five years. Dee tells Mama if she got to take the quilts she would hang them, she says this as if hanging quilts was something of the norm . Maggie finally breaks her silence and tells Mama that Dee can keep the quilts and that she will remember Grandma with or without them. Even though that is what Maggie said, Mama picked up the quilts and laid them on her lap anyway. She told Dee to take one or two of the other ones. Dee told Maggie to make something out of herself and then she left. The central theme of â€Å"Everyday Use† is the theme of heritage. In â€Å"Everyday Use†, Walker’s theme is greatly based on heritage. She shows this is multiple ways. One of the ways she shows this is by Mama becoming offended in Dee’s name change. Dee comes home from college announcing to Mama that she has changed her name to â€Å"Wangero Leewanika Kemanjo. (746)† Mama asks â€Å"What happened to Dee? (746)† Where Dee then responds with â€Å"She’s dead.† Dee expresses her thoughts on not liking being named after the people who oppress her. Mama then explains to her that she wa s not named after the people who oppress her but after her aunt and grandmother. She even says that she could probably trace back the name â€Å"Dee† back before the Civil War. Walker uses the name as a symbol of family tradition and unity. She takes advantage of the dialogue between Mama and Dee to showShow MoreRelatedConflict of Characters in Alice Walkers Everyday Use722 Words   |  3 Pages In Alice Walkers Everyday Use† she creates a conflict between characters. Walker describes a family as they anxiously await the arrival of, Dee, the older sister of the family. When Dee (Wangero) comes home to visit Mrs. Johnson and Maggie, right away the readers see the differences in the family by how they talk, act, and dress. Dee has changed her name to an African name and is collecting the objects and materials of her past. Dee thinks that since she is in college she knows mores then theRead More The Character of Dee in Alice Walkers Everyday Use Essay879 Words   |  4 PagesThe Character of Dee in Alice Walkers Everyday Use Alice Walker skillfully crafts the character of Dee Johnson in the short story Everyday Use. From the first paragraph, Walker begins to weave the portrait of Dee, who at first seems shallow in many aspects. Dee becomes a more complex character, however, as the story unfolds. Blessed with both brains and good looks, Dee emerges as someone who is still struggling with her identity and heritage. Dees physical beauty can be definedRead MoreEveryday Use by Alice Walker: A Look at Symbolism and Family Values879 Words   |  4 PagesAlice Walkers â€Å"Everyday Use†, is a story about a family of African Americans that are faced with moral issues involving what true inheritance is and who deserves it. Two sisters and two hand stitched quilts become the center of focus for this short story. Walker paints for us the most vivid representation through a third person perspective of family values and how people from the same environment and upbringing can become different types of people. Like most peoples families there is a dynamicRead MoreEssay about Autobiography in the Fiction of Alice Walker1077 Words   |  5 PagesWhen reading Alice Walker’s â€Å"The Color Purple† and â€Å"Everyday Use,† it is evident that she writes about her life through her use of allegory. Alice Walker uses the events of her childhood, her observation of the patriarchy in African American culture, and her rebellion against the society she lived in to recount her life through her stories. Alice Walker grew up in a loving household in the years towards the end of the Great Depression. Although her family was poor, they were rich in kindness andRead More(A Critical Analysis of Alice Walker’s short story Everyday Use)700 Words   |  3 PagesAntojos de Mis Ojos (A Critical Analysis of Alice Walker’s short story Everyday Use) Albert Camus once asserted: â€Å"Men are never convinced of your reasons, of your sincerity, of the seriousness of your sufferings, except by your death. So long as you are alive, your case is doubtful; you have a right only to their skepticism.† In Everyday Use a strong willed mother tries to protect her younger daughter, Maggie, from having a quilt passed down for generations stolen from her by her materialisticRead MoreAn Analysis Of Alice Walker s Everyday Use989 Words   |  4 PagesEnglish 102 22 January 2015 Heritage: The Various Interpretations in Alice Walker’s â€Å"Everyday Use† According to The Merriam-Webster Dictionary (2015), heritage is defined as, â€Å"traditions, achievements, beliefs, etc., that are part of the history of a group or nation† (â€Å"Heritage†). Heritage takes on mixed meanings for different people as a consequence of life experiences and belief systems. Alice Walker’s â€Å"Everyday Use† utilizes characters with varying ideas of â€Å"heritage† to enlighten the world of theRead MoreAlice Walker s Everyday Use906 Words   |  4 PagesHidden Messages A Critique of Alice Walker’s â€Å"Everyday Use† Title Often authors use the titles of their writing to portray a part of the story that will eventually come up, or to give an underlying message about what’s going on in the story. In Alice Walker’s short story, Everyday Use, she uses a title that isn’t blatantly seen within the story, but is explained through different aspects of the dialogue and actions of the characters. Walker could’ve chosen to explain the title more obviously withinRead MoreAn Analysis of Alice Walkers quot;everyday Usequot; Essay929 Words   |  4 Pagesp An Analysis of Alice Walkers Everyday Usep Alice Walkers novel, The Color Purple, won the Pulitzer Prize in 1982. This novel, in addition to her short story collections and other novels, continue to touch the emotions of a vast audience. This ability, according to critics, has solidified her reputation as one of the major figures in contemporary literature (Gwynn 462). Born to sharecroppers in Eatonton, Georgia, in 1944, Alice Walkers life was not always easy. Her parents strived toRead MoreThemes Of Racism And Poverty1495 Words   |  6 Pagespoverty in the black community, there are elements of both themes in August Wilson’s Fences, Alice Walker’s â€Å"Everyday Use,† and Gwendolyn Brooks’ â€Å"What Shall I Give My Children.† By critically evaluating the main characters in each piece, elements of racism and poverty are identified in all three texts. All three of these texts show the hardships blacks experienced and how they suffered. In Fences, â€Å"Everyday Use,† and â€Å"W hat Shall I Give My Children,† there are themes of racism and poverty in black AmericaRead MoreDead Mens Path Literary Analysis1000 Words   |  4 Pagesvillagers go. â€Å"Everyday Use† by Alice Walker shows conflict between Mama, Dee, and Maggie. Dee wants to take the quilts away from her home, but Mama already planned to give the quilts to Maggie. Both literatures are relatable to readers. However, one literature shows a stronger connection readers can relate too. â€Å"Everyday Use† by Alice Walker distinguishes a more relatable conflict to modern day readers than â€Å"Dead Men’s Path by Chinua Achebe because readers connect the short story to everyday problems