Promotion of Effective Communication †Workbook Essay Example for Free

Promotion of Effective Communication – Workbook Essay Question  1 Look at your company’s policies and procedures on completing records and maintaining effective communication, what is your role? Answer: I browsed and read my organisation’s policy regarding the service user’s rights and those legislations which promotes equality, diversity, and discrimination. a. Each service user has a right to information regarding their care service that does not discriminate on the basis of race or ethnic origin, creed, colour, religion, political affiliation, disability or impairments, marital status, parenthood, sexual gender or sexual orientation. b. Each service user has the right of access to their personal care records and to comment on them accordingly. Service users have the right to appoint an advocate to make their wishes and preferences known if they are unable to do so. c. Each service user has the right to be assured that no personal or confidential information concerning their affairs will be disclosed to a third party without their express permission. d. Each service user has the right to communicate using their preferred methods of communication and language. When completing records and reports look through your staff hand book or induction pack you were given at work and explain any rules and regulations or policies you need to follow when completing records and reports at work some of which might include: †¢ Records should be completed as soon as possible after the event †¢ Details should be accurate †¢ Details should be relevant †¢ Details should be legible †¢ Details should clearly indicate if it is a fact, opinion or hearsay. Opinions are acceptable as long as it is clearly stated as such. †¢ Always record as little as possible but detailed and as much as necessary. 2, 3, 10, 11 Describe ways that you provide support to individuals to communicate their needs. How might your communication alter with different individuals ? What aids might be used to support effective communication ? Answer: To support individuals and key people to communicate their needs you will need to: a. Arrange the individual’s environment to facilitate effective communication and promote understanding. This can be done by ensuring privacy going into a quiet room, if the area is noisy because of the volume of a radio or television it needs to be reduced. Poor lighting in the room needs to be changed and some more that you can think of. b. As a care worker you need to check that the individual have the appropriate support to communicate their views. This could be making sure the individual who uses glasses and an hearing aid is supported by making sure the glasses is at client’s reach or that hearing aids is switched on and working properly. c. Appropriate styles and methods of communication should be used with respect to the individual. Such as: Active listening – showing be gestures that you are listening, sitting or standing half turned away gives the message that you are not listening. Responding appropriately – nodding your head.  Good body language and maintaining eye contact – Leaning forwards can be used effectively when you want to emphasize your interest or support. The methods that can be used to communicate effectively are: a. Support equality and diversity †¢ This can be done by using appropriate language that the service user understands also using the appropriate register of language, for instance not using phrases that could be referred to as jargon. Another method is to use the appropriate way of speaking within a speech community. For instance communicating with young people may mean using their style of language e.g. whats up with you, hello mate. †¢ Provision of communication aids and use of non-verbal communication if service user has hearing or vision impairments or learning and physical disabilities. b. Are effective when dealing with, and challenging discrimination †¢ Working with key people demands that you communicate in a language that they understand and also using simple words. For example the use of clinical words that is not commonly understood would not be necessary if you know they are not familiar with them. †¢ Sometimes we come across people who cannot understand us for one reason or the other instead of ignoring them it would be helpful to source a skilled interpreter but we still need to make effort to communicate with the person by learning some of the ways of communication or a few useful words from their language. The methods to support individuals to communicate are: Ensure environment is suitable (lighting, noise background) Provide interpreter if necessaryAllow sufficient time for individuals to understand the content of communication. Use relevant aids for communication (e.g. cards, symbols, hearing aids, large print) Provide advocate to speak for a service user Ensure written material is in suitable formats or language. Specific aids that may be used to support effective communication : Aided communication is communication supported or replaced by materials or equipment. There are simple materials or equipment used everyday such as a pen and paper to write messages, alphabet charts, pictures or symbols or photographs. Communication aids can be categorized into 3 broad groups: Symbolic Aids This is commonly the use of signs and symbols, it requires individuals to undertake a form of training on the correct forming of signs used and types of symbols: †¢ British Sign Language used as a communication aid for individual with hearing loss. †¢ Makaton used as an aid to support speech and not intended to replace it. †¢ Picture Exchange communication systems (PEC) This aid helps individuals to be independent as they able to exchange a picture for what they want from a compiled album of pictures. †¢ Deaf Blind manual alphabets Slightly modified version of the BSL. Finger- spelling alphabet is used. Technical Aids †¢ Talking microwaves usually for individuals with sight loss †¢ Computers which read out the text on the screen. †¢ Light writer this is a portable device into which the individual types in what they would want to say. Human Aids †¢ Interpreter is a person who supports the communication between two people who do not have the same language. This also includes the sign language. †¢ Translator is a person who changes the written word into an easier format for the individual to read. This could be into Braille or symbols. †¢ Advocate This is someone who speaks on behalf of an individual when they are not able to do so. 4, 5, 19 In relation to the promotion of effective communication, give examples of what you do to maintain the following laws and guidelines: a) Data Protection Act b) Access to Health Records Act c) The General Social Care Council Code of Conduct d) Standard 37 National Minimum Standards for Care Homes e) Caldicott Report Answer: a) To maintain Data Protection Act it is necessary to complete the records as soon as possible after the event and always record as little as possible but detailed and as much as necessary; to make sure that the details are accurate, relevant and legible and that they clearly indicate if it’s a fact, opinion or hearsay. Another important thing is that opinions are acceptable as long as it is clearly stated as such. The information shared by the individuals must be confidential to ensure data protection. In case that the information suggests that the client is under risk, the consent of the individual needs to be obtained before passing the information to an appropriate member of the staff, and even when the consent is not given it becomes important to report. b) To maintain the Access to Health Records Act I have to make sure that the records are accurate, legibly written, shareable so that the information can be used to provide individuals with the support and care required. The  members of a care team are fully informed of new developments and changes in a client’s care plan and the evidence of the actions taken in specific circumstances are available if the need arises. I can access information and records about an individual by: talking to the service user, accessing previous records after permission has been sought from the appropriate person, talking to colleagues who know the individual, to family members or to other professionals c) To maintain The General Social Care Council Code of Conduct, as a social care worker, I must establish and ensure the confidence of service users and carers. This includes: communicating in an appropriate, open, accurate and straightforward way; respecting confidential information and clearly explaining agency policies about confidentiality to service users and carers. I must be accountable for the quality of my work, I have to maintain clear and accurate records required by procedures established for my work. 6,7 Where can you find out about an individuals communication and language needs, information about communication and language skills to improve your practice ? Answer: I can find out about an individuals communication and language needs by asking my manager or the service user, discussing with other care workers who know the individual, talking to family members, to a speech therapist or other professionals for advice, exploring the internet or consulting a library for more information. In order to improve my practice, I can find out about information, communication and language skills by asking my supervisor or manager, or colleagues who have confronted with similar cases. I can also consult the case notes of the individual, or relevant documents provided by the organization that will help me learn how to communicate effectively – for example the induction manuals, search for information via the internet or specialist organizations for the particular condition, attend relevant training courses to communication, supervision and appraisal sessions. 9  What factors may affect communication skills, abilities and behaviour of an individual ? How may they react as a result of these factors? Answer: Factors that can affect communication skills, abilities and behaviour of an individual are: Physical Impairments visual and hearing Language barriers accents, different language Cognitive or sensory impairments learning difficulties, memory loss, Illness – dementia, stroke Environmental problems – poor lighting, noisy environments If this happens, the individual in question becomes withdrawn from others around them, isolated from others. This may affect his self-esteem and self-confidence negatively. That individual may also become confused, angry and frustrated. 12  If you were trying to have a conversation with an individual how would you arrange the environment and position yourself to communicate effectively? Answer: First of all, I have to make sure that there isn’t any background noise that could make the communication difficult. Then, another important step to achieve effective communication with individuals is arranging the environment to aid communication. Here are some factors that can hinder or disturb good communication: Poor lighting, because individuals with poor sight are unable to see you Background noise from the radio, other individuals, TV and so on Obstacles between me, the care worker, and the individual, for example furniture and household items Insufficient distance to keep appropriate space within me and the individual to avoid encroaching or invading on their personal space 13, 14  Describe some conflicts that might occur as a result of communication difficulties. How would you deal with these conflicts? Answer: Some of the conflicts that might occur as a result of communication difficulties are: individuals can become frustrated and isolated when the  communication between themselves and their workers is encountering problems. These problems or dilemmas are sometimes the result of: a difference in the language spoken by the service user and the worker the service user has visual impairments or hearing difficulties the individual might have a physical illness or disability either physical disability or learning disability. There are many ways to solve the conflicts that might occur. It depends on the nature of the problem. For example, for: †¢ Language differences: If there are conflicts due to language differences, then an interpreter will be appropriate for any serious discussions or communications. Efforts should be made to learn a few important words to communicate with the individual or teach the individual some words in the workers language if they are willing to facilitate communication. Non verbal communication will be an effective method in solving this kind of conflict. †¢ Hearing difficulties: Individual with hearing difficulties need to be assisted to ensure their hearing aids are working and fitted properly. It would be necessary that a worker will assist the individual to clean the equipment, change the batteries when appropriate. Workers will also need to give the client the appropriate space and communication pace that would make communication effective. If the need arises words can be written down for clarity. The use of signs and telecommunication services such as type talk service are very useful. †¢ Visual difficulties: Individual with visual difficulties need to be provided with glasses or contact lenses so they can observe non verbal communication. This will prevent misunderstandings during communication with people. †¢ Physical disabilities: Communications with individuals in this category will be according to the type of physical disability or illness. If the illness has affected the individual’s ability to speak and understand, for instance a stroke then the use of short, simple sentences, gestures, writing and drawing or using flash cards, the use of closed questions which only need yes or no should be useful. †¢ Some illness do not affect the clients understanding, so there is no need to speak slowly but will need to be patient to receive a response as the client might have difficulty with their speech e.g. stroke. †¢ Learning disabilities: The method of communication will depend on the level of the disability. I will need to communicate at the pace and space suitable for the client. Physical contacts are of an advantage to be used along with  verbal communication. †¢ Cultural differences: People have different cultural backgrounds, therefore it is necessary to find out from the individuals their communication preferences or alternatively check their care plan records or ask people such as their family, f riends, colleagues or key people who have worked with them. 15, 16  When communicating difficult, sensitive or complex messages, how might your style of communication alter? What type of environment would be most appropriate for this sort of communication ? Answer: Communicating with individuals who are distressed or upset due to bereavement this could be sensitive, complex or difficult. In this situation, I will ask if the person would want to discuss any concerns with me or maybe another person of their choice. I can use non verbal communication while been a good listener such as making good eye contact with the individual as she talks, which will depict that I’m willing to listen. If the client is displaying a behaviour that dictates that they are able to put others or themselves at risk, then I might need to involve the attention of appropriate members of the care team. For this sort of communication, the environment must be comfortable and appropriate. I would come across times when I need to discuss matters with individuals that are referred to as sensitive issues. If an individual needs to discuss his personal needs with me, I have to ensure that he feels comfortable and encouraged to communicate these issues. On the other hand, I might want to discuss with the service user about their changing needs such as diet, incontinence, mobility and so on. Communicating bad news, like a bereavement of a spouse or close person to the individual will also require certain communication skills. The things that should take into account are: †¢ Remember individuals have a right to their privacy, therefore the immediate environment should be arranged to ensure privacy. For example a client’s bedroom or apartament should be free from visitors at the time. †¢ Individual’s preferred method of communication should be made available. †¢ Communication should be made at the pace of the individual, giving enough time for both of us to understand the content of the communication. †¢ Observe and respond appropriately to reactions fromà ‚  individuals. 17  Who do you need to gain permission from to access records and why ? Answer: I need to gain permission of my manager or client to access records. Accessing information will help me to improve my practice and also my responsibility. Within the organization there should be relevant documents to access information or if I work with individuals in their own home the care plan should contain useful information. 18  Define the following words: a) Fact b) Opinion c) Judgement Why is it important that you aware of the difference of these words when reporting and recording information about individuals ? Answer: a) A fact is a true statement that cannot be disputed, knowledge or information based on real occurrences; something demonstrated to exist or known to have existed. b) An opinion is a personal belief or judgment that is not founded on proof or certainty- it is the result of emotion or interpretation of facts, a subjective statement or thought about an issue or topic. An opinion may be supported by an argument, although people may draw opposing opinions from the same set of facts. c) A judgement is a cognitive process of reaching a decision or drawing conclusions. Judgments are also personal and developed from experience; they differ from person to person. For example, if a client is dying and all the symptoms and signs show the evidence, reports and records should show these facts. On the other hand if the client only refused to talk, people might have different opinions and judgments to explain the reason. Records and reports will need to be verified to deduce the correct and most suitable reason. It is important to aware of the difference of these words when reporting and recording information about individuals because I have the responsabiliy to provide seamless services for individuals, and this thing can be done only if the  information is correct, precise.

Non Medical Independent Supplementary Prescribers Nursing Essay

Non Medical Independent Supplementary Prescribers Nursing Essay The purpose of this essay is to explore some of the processes involved in prescribing, from consideration of the patients pathophysiology, through consultation and decision-making to the provision of treatment. The authors rationale for choosing anticoagulation as the topic for discussion, is that although the authors field of practice is mainly with patients who have ischaemic heart disease, upon reviewing the practice log it became apparent that developments within the authors role were leading the author to participate more in the care of patients with atrial fibrillation. To highlight discussion and link theory to practice the author will use four case studies of patients admitted to a district general hospital, who subsequently were diagnosed with atrial fibrillation and due to the nature of the condition, were offered anticoagulation for the prevention of future thromboembolic events. The above processes will be discussed under the headings of the learning outcomes below. Evaluate effective history taking, assessment and consultation skills with patients/ clients, parents and carers to inform working/differential diagnoses. Integrate a shared approach to decision making taking account of patients/carers wishes, values, Religion or culture. Traditionally patient consultations have been performed with the doctors taking the more dominant role (Lloyd Bor 2009). These consultations have been doctor-centred, establishing a diagnosis and treatment plan without involving the patient in the decision making process. At this time this was accepted by the patient because the doctor knows best and the patient handed over responsibility for his well-being to the clinician. However this has now changed and patients are more interested in their illnesses, wanting to know more and be involved in their treatment plans. Increasing evidence suggests that a more patient-centred style of consultation results in happier patients who are more likely to adhere to their treatment plans (Stewart et al 2003). The author was able to observe her designated medical practitioner (DMP) in a variety of patient interactions but mainly during the process of consultation, for the purpose of establishing diagnosis and treatment plans, (see appendix for case studies). Consultations are made up of a number of elements such as establishing a rapport, gathering and interpreting information and physical examination, however the cornerstone of all patient interactions is effective communication. Prior to each consultation, the DMP prepared by reading through the medical records to obtain information regarding the patients past and present history, medications and allergies. At this stage consideration was given to potential treatment plans or required tests. The patients in case studies 1-4 were all admitted to hospital due to either new onset of symptoms or deteriorating clinical condition, thus each consultation was held at the bedside. Hastings (2006) highlighted the importance of recognising the different settings within which a consultation can occur and how these settings can affect the patient and practitioner. This is a view shared by White (2002) who felt that the environment can greatly influence the consultation process. Upon reviewing the literature the author has found that there are many different approaches that can be adopted and various consultation models that can be utilised, in order to produce the most effective consultation. The author felt that the DMPs methods of consultation spanned several models. It incorporated elements of the biomedical model described by Byrne Long (1976), in which they describe six phases which formed a logical structure, but take a very doctor-centred approach (see appendix). Charlton (2007) argues however, that whilst this model is simplistic and logical it has difficulty accommodating the feelings, beliefs and psychosocial issues which colour the meaning of health and illness. The consultations also incorporated elements of the more patient-centred models as described by Pendleton et al (2003) and Calgary-Cambridge (1996), see appendix **. These models aim to achieve a collaborative understanding of the patients problems. The authors DMP combined traditional m ethods of history taking with systematic physical enquiry and examination, to elicit information about the patients medical, social and family histories, together with drug and allergy information, and the patients perspective regarding their history and presentation of symptoms. Once the history was obtained the physical examination was performed to supplement the diagnostic process. In each case the examination was cardiovascular, paying particular attention to the auscultation of heart sounds, because in atrial fibrillation the exclusion of a valvular element is necessary prior to commencing anticoagulation. In accordance with the models used, diagnosis was established and discussed with the patient. The DMP used simple terminology to ensure understanding. The use of non-verbal communication was evident throughout each consultation, from the outset where introductions and shaking hands took place, to the use of empathy and touch when the patient showed fear and anxiety. The history taking process may have involved a doctor-centred approach but the discussion surrounding treatment choices was certainly patient-centred. In each consultation the plan between the patient and the DMP was negotiated, with the DMP explaining the risks associated with atrial fibrillation, and being honest with the patient about the risks versus benefits of anticoagulation. Charlton (2007) believes that it is important to elicit a patients concerns and expectations in order to ensure that both the patient and the doctors agendas are the same. This is supported by Neighbour (2005) who stated that, Patients differ widely in their factual knowledge, in their beliefs, their attitudes, their habits, their opinions, their values, their self-images, their myths, taboos and traditions. Some of these are relatively labile and easy to change on a day to day basis, others are more firmly held and difficult to alter. Each patient we encounter will have come from a different background and some from different cultural systems whereby their values, beliefs and behaviours may not be the same as the practitioners (Lloyd Bor 2009). Each patient within the sphere of their culture or religion will have a different view about what treatments or care is acceptable (Helman 2000). This was the case in respect of patient * who was a Jehovahs Witness. Patients who share this religion do not accept blood transfusions or blood related products based upon their interpretation of Acts, a book in the New Testament Bible (Wikipedia 2012). Although the authors DMP and the patient were from different cultural and religious backgrounds, effective communication was still maintained. The DMP took time with the patient to explore the implications that the patients beliefs would have upon the form of treatment that was indicated. In this case it was not taking the drug that posed the problem but the increased risk of bleeding that could occur, which potentially may require a blood transfusion if the bleeding were to be severe. In the case of patient * they initially were not keen to start warfarin. When it was first mentioned the patient grimaced and said oh, isnt that rat poison. Indeed the patient was correct, Warfarin has previously been used to kill rodents but its safety and efficacy as a medication has also been proven. Patients often have misconceptions about medication which can influence their decision making. Their decisions regarding treatments are based upon their understandings and these can often by influenced by external factors such as the media. However, with regard to the consultations observed by the author, it seems that the intrinsic factors were more influencial. Patient * and * were both concerned about potential lifestyle changes. How often would i need to come for tests? What about going on holiday? Will I bruise easily? What happens if I cut myself? Will it affect my other medicines. For patient * the answers were acceptable and warfarin was prescribed. However patient * felt that the change would be too much and declined. Respecting a patients right to refuse treatment is part of the consultation and prescribing process. In its guidance on consent, the GMC (2008) discusses the importance of accepting that a competent patient has the right to make decisions about their healthcare and that doctors must respect these decisions, even if they do not agree with them. This view is supported by NICE (2009) who state that patients if they chose to, should be involved in the decision m aking process, and as long as they have mental capacity, as defined in the Mental Capacity Act (2005), to be able to make informed choices, as professionals we must understand that patients have different views to us about risks and benefits and we must accept their right to refuse. For patients ***and *, the recommended treatment was anticoagulation. Patient * and * once their initials concerns were addressed, were happy to proceed with the treatment. Patients * and * were not. The author noted that this did not change the DMPs treatment of the patient, who respected their decision and agreed an alternative plan. Although each consultation was different in the patient specifics, there were still common elements. Each interaction was structured and was systematic in establishing the required elements. A good rapport was established with each patient, resulting in effective communication. Communication problems between the doctor and patient can lead to dissatisfaction (Simpson et al 1991), causing misunderstandings and lack of agreement or concordance with treatment plans (Barry et al 2000). This was not the case however in patient * and *. Each patient was given a full explanation of the treatment options and each made an informed choice regarding their treatment, choosing to pursue a path not recommended by the authors DMP. A review by Cox (2004) summarised that patients and health care professionals need to have a two way discussion in order to share their views and concerns regarding treatment. 6. Integrate and apply knowledge of drug actions in relation to pathophysiology of the condition being treated. With the advent of independent and supplementary prescribing, and the ever changing role of the nurse, it is considered imperative that nurses have a greater knowledge and understanding of drug pharmacology (Thomas Young 2008). Pharmacokinetics studies how our bodies process drugs and Pharmacodynamics studies how these drugs exert their effect (Greenstein Gould 2009). When the heart beats normally, a regular electrical impulse causes the muscular heart walls to contract and force blood out and around the body. This impulse originates in the top chambers of the heart (atria) and is conducted to the bottom chambers (ventricles). In atrial fibrillation this impulse is initiated and conducted in a random uncoordinated manner causing the heart to function less efficiently. The risk of a pooling or stasis of blood remaining in the heart, increases the risk for a thromboembolic event. Atrial fibrillation is the most commonly sustained cardiac arrhythmia affecting 10% of men over 75 years (NHS Choices 2013) and if left untreated is a significant risk factor for stroke (NICE 2006). The patients identified in the case studies were all given a diagnosis of non-valvular atrial fibrillation. Their individual risk for thromboembolic event was assessed using the CHAD scoring systems and the outcome was that each patient required treatment with anticoagulation. Anticoagulants were discovered in the 1920s by a Canadian vet who found that cattle eating mouldy silage made from sweet clover were dying of haemorrhagic disease, and it wasnt until the 1950s that anticoagulants were found to be effective for preventing thrombosis and emboli by reducing clot formation, and were finally licenced for use as medicines. (Wikipedia 2012). Warfarin is the anticoagulant most commonly used in the treatment of atrial fibrillation. To understand the pharmacodynamics of warfarin, one must first understand the basic clotting cascade. Blood contains clotting factors (inactive proteins) which activate sequentially following vascular damage. These factors form two pathways (Intrinsic and Extrinsic) which lead to the formation of a fibrin clot. The extrinsic pathway is triggered by tissue damage from outside of the blood vessel. It acts to clot blood that has escaped from the vessel into the tissues. Damage to the tissues activates tissue thromboplastin which is an enzyme that activates Factor X. The intrinsic pathway is triggered by elements that lie within the blood itself. Damage to the vessel wall stimulates the cascade of individual clotting factors which also activate Factor X. Once activated Factor X converts Prothrombin to Thrombin which in turn converts Fibrinogen to Fibrin. Fibrin fibres then form a meshwork which traps red blood cells and platelets and so stems the flow of blood (Doohan 1999). Vitamin K is essential for the maturation of clotting factors such as Factor X and prothrombin and it is on Vitami n K that anticoagulants such as Warfarin take effect. Warfarin reduces coagulation by inhibiting the processing of Vitamin K. This reduces the amount of matured clotting factors available for the clotting cascade, causing clotting time to be prolonged (Melnikova 2009). This time frame can be measured by testing a patients INR (International Normalised Ratio), which is simply a recording of the amount of time it takes for a blood sample to clot. Using Warfarin in the treatment of Atrial Fibrillation, reduces the risk of clot formation and the risk of potential clots being ejected from the heart into the general circulation. This process however is dependent upon how the body initially processes the drug (pharmacokinetics). Warfarin is readily absorbed from the GI tract, however this can be affected by age related changes such as reduced gastric emptying and slowed motility affecting intestinal transit time. This phase determines a drugs bioavailability. The extent of drug distribution depends on the amount of plasma proteins and whether a drug is bound or unbound. Warfarin is 99% bound to plasma proteins and therefore takes longer to reach the site of action, thus the distribution phase lasts approximately 6-12 hours (Holford 1986). The patient in case * was noted to be on aspirin. Patients on drugs which bind at the same site can cause problems when administered together, as one displaces the other causing elevated levels o f the drug to be circulating, leading to toxicity (Sunalim 2011). Whilst the benefits of warfarin are apparent the side effects and precautions for use are numbered. Warfarin has a narrow therapeutic window making control difficult and increases the risk of bleeding and haemorrhage. It interacts with other prescribed, over the counter and herbal medicines and is contraindicated in pregnancy. Despite its use in clinical practice for over 50 years, the MHRA still receive a substantial number of adverse reaction case reports through the Yellow Card system. The majority of these reports were as a result of over anticoagulation with the majority of fatal cases being attributed to haemorrhage. It was concluded that in some cases interaction with other medications was the cause (MHRA 2009). It is therefore essential that a full drug history including allergies is taken prior to commencing any new medication. Critically appraise sources of information/advice and decision support systems in prescribing practice and apply the principles of evidence based practice to decision making. 9. Demonstrate an expert understanding of prescribing decisions made within an ethical framework with due consideration for equality and diversity. The decision to prescribe an anticoagulant such as warfarin is not a decision taken lightly. Due to the potential side effects, mainly the increased risk of bleeding, the risks versus benefits discussion must be explored. The benefit of warfarin is the reduction in risk of thromboembolic events such as a stroke or pulmonary embolism, the risks areà ¢Ã¢â€š ¬Ã‚ ¦however before this discussion can take place, it must first be established whether anticoagulation with warfarin is needed or whether an alternative treatment is possible. In 1994 the Atrial Fibrillation Investigators (AFL), conducted randomised clinical trials whose participants had untreated atrial fibrillation. Data from these trials showed that patients with previous stroke, hypertension or diabetes were at increased risk of stroke. This data was confirmed by the Stroke Prevention Atrial Fibrillation Investigators (SPAF 1995) who looked at thromboembolic risk for AF patients on aspirin. The amalgamation of these two bodies in 2001 led to the development of the CHAD2 scheme (see appendix), which is a clinical prediction tool used for estimating the risk of stroke in patients with AF and to determine whether or not treatment is required with anticoagulant or antiplatelet therapy. Risk stratification schemes that accurately and reliably stratify stroke risk could influence the management of those who have AF and spare those low-risk patients the risks, inconvenience and costs associated with anticoagulation therapy (Gage et al 2004). The use of the C HAD2 and CHAD2VASc score is advocated in the European Society of Cardiology (ESC) guidelines (2010), which recommends that if the patient has a CHAD score of 2 or above anticoagulation therapy such as warfarin or one of the newer drugs, such as dabigatran, should be prescribed. This view is supported by NICE guidance (2006) which analysed respective trials and concluded that warfarin significantly reduced the incidence of stroke and other vascular events in people with AF. NICE also discusses stroke risk stratification models, of which the CHAD2 score is one. It does not however make recommendations as to the best choice of tool. Patient * was the only one out of the case studies that had their stroke risk calculated using the CHAD scoring system and had it recorded in the notes. The reasons for this are unknown however the author hypothesises that perhaps as the other patients had greater apparent risk due to their existing co-morbidities, it was deemed unnecessary to actually perf orm the calculation as anticoagulation would ultimately be indicated. The author could argue here that if this was the case this generalisation goes against the concept of diversity. Warfarin has been widely accepted as the drug of choice for oral anticoagulant therapy, however newer drugs on the market such as dabigatran and rivaroxban have also been recommended as alternatives to warfarin , yet it is the authors experience that these are very rarely discussed with patients as alternative treatment and only seem to be prescribed when warfarin is not an option. The author believes the reason for this may be partly due to economic and geographical inequalities in health, a view shared by Abraham Marcy (2012) Wartak Bartholomew (2011). They concluded that compared to warfarin dabigatran was disadvantaged by the lack of knowledge about its use, its poor gastrointestinal tolerability and ultimately the cost which resulted in its limited use. Treatment decisions made for these patients were in keeping with National and European guidelines promoting access to treatment for all. Local guidelines however are under current review and were not available for scrutiny. As prescribers we must use all available information to ensure that we make the best evidence based prescribing decisions with our patients. Guidelines facilitate best practice but resources such as the British National Formulary (BNF) and the Electronic Medicines Compendium (EMC) are invaluable reference tools in facilitating best prescribing practice. In everyday practice healthcare professionals are expected to make judgements about what is best for their patients. The NMC (nnn) advocate that to practice in an ethically sound manner it is necessary to balance ethical considerations with professional values and relevant legislation. The ethical theory of principlism described by Beauchamp Childress (2008) considers the principles of beneficence, non-maleficence, autonomy and justice as the elements of ethical theory that are the most compatible in supporting decision-making within the healthcare system. Making ethical prescribing decisions is not a solitary activity, especially when the decision will impact upon another person. The ethos of quality patient care relies upon a team approach that supports the decision making of the patient, in partnership with the professionals, ensuring that the values and beliefs of the patient have been respected and acknowledged. 5. Demonstrate critical awareness of the roles and relationships of others involved in prescribing, supplying and administering medicines. Earlier discussion highlighted the importance of communication in developing the doctor-patient relationship and how consultations are either doctor or patient-centred. This is also true with regard to other professional relationships the patient may have with members of the multidisciplinary team, who are also involved in prescribing, supplying and administering their medications. A review of the supply, prescribing and administration of medicines by the DOH (1999), recommended that there should be two types of prescriber; independent and supplementary. An independent prescriber is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management requiredà ¢Ã¢â€š ¬Ã‚ ¦.supplementary prescribing is a voluntary partnership between a doctor or dentist and a supplementary prescriber to prescribe within an agreed patient specific clinical management plan, with the patients agreement NPC (2012). As a potential non-medical prescriber the author recognises the importance in understanding and applying the principles of good prescribing practice, in order to become an independent/supplementary prescriber. Doctors undertake training in prescribing as part of their undergraduate programme and are required to demonstrate this activity in order to obtain their registration. Their practice is guided and governed by the General Medical Council (GMC). Likewise nurses and midwives who are independent/supplementary prescribers, are governed by the Nursing and Midwifery Council (NMC), whose regulatory standards and legislation require practitioners to be experienced before they undertake such training and in safeguarding the best interests of the patient, ensure that nurses and midwives remain up to date with the knowledge and skills that enable them to prescribe and administer drugs safely and effectively (NMC 2004, NPC 2012). Pharmacists whose governing body, the General Pharmaceutical Council (GPC 2010), allow that a pharmacist independent prescriber may, after successful completion of an accredited course, prescribe autonomously for any condition within their clinical competence. Current legislation however only allows other multidisciplinary members such as radiographers and physiotherapists to be supplementary prescribers. During a patients stay in hospital, it is most likely they will enter into a medication consultation with at least one or two of the multidisciplinary members mentioned above. All the patients in the case studies had contact with a doctor, nurse and pharmacist. The doctors performed the initial consult at the patients admission and it is here that the initial drug history was taken. The nurse then administered the medication prescribed on the drug chart, giving the patients information about the drugs they were taking and potential side effects. This information was limited to their individual knowledge base. If the drug was unavailable then it was requested from the pharmacy department. The author observed the practice that occurred when an unavailable drug was requested. The initial process was simple, the doctor prescribed it and the ward nurse sent the drug chart and request slip to pharmacy. Once in pharmacy the process became more complex requiring the request to pass through s everal stations before being dispensed. Prior to this course the author had very little understanding as to how important the role of the pharmacist was. Pharmacists play an important role in improving a patients medication management during admission and through transitions of care from hospital to home. Weiss (2013) agreed that patients are often discharged from hospital with changes from their previous medication regimes, causing discrepancies and lack of understanding, which lead to non-adherence and adverse drug effects. The pharmacists spoken with by the author agreed that providing medication counselling in preparation for discharge is a large part of their role. Patient * and * who were commenced on warfarin, received counselling prior to discharge. The author was able to observe this practice. The session took place at the bedside which, upon reflection, was not conducive to this information exchange. Noise and interruptions from a confused patient in the next bed meant that the passage of information was often disrupted and had to be repeated. The pharmacist provided the patient with an information pack and discussed the drug, side effects, anticoagulant monitoring and lifestyle changes such as travel, diet, recreational activities and dental visits. NICE medicines adherence guidance (2009) advocate the importance of providing patients with both written and verbal information in order to make an informed choice. For patient * and *, verbal information was given prior to prescription, but the written information was only provided after the patient had agreed to treatment. Providing all the information beforehand could increase patient conse nt to treatment (Elwyn et al 2006). Considering the role of others within the prescribing team has led the author to examine and reflect upon her own role. The author entered this course with knowledge and competence in diagnosing a patient with an acute coronary syndrome and questioned why such a broad prescribing knowledge was necessary. It is the view of Lymn et al (2010) that non-medical prescribers within a narrow specialist field often ask this question. Taylor Field (2007) believe the answer to be because advancements in medicine have meant that patients are often able to live with chronic disease and multiple co-morbidities. Becoming a prescribing student has given the author insight into what she did not know and what she never realised she needed to know. Conclusion. At the beginning the author posed the question, Anticoagulate or not to anticoagulate? In order to answer this, the author explored some of the processes involved in prescribing and through the use of case histories, linked theory to practice with analytical discussion. The answer to the question is clear, there is no one true answer. It is the authors conclusion that each case for anticoagulation must be viewed separately. Each patient is different, their understanding, their views and their pathophysiology all are unique. As practitioners it is our duty to provide our patients with the information and support they need in order to make informed choices. As prescribing practitioners these responsibilities are increased. Using the process of accountable practice as described by Lymn et al (2010), it is essential that we analyse our responsibilities as accountable prescribers and in doing so consider each prescribing situation on its own merits.

A Primitive Civilization In A Failed Utopia Essay -- essays papers

A Primitive Civilization In A Failed Utopia Symbolism can be used to represent many aspects of a person place or thing. Throughout the novel the boys lose all symbols that represent there civilization such as there clothes and uniforms. In this novel symbolism is used to show how the boys change their outlook on their primitive society and rules. They are used in the novel Lord of the Flies to show the deterioration and destruction of the boys society and rules. The conch, the glasses and the masks all have a greater meaning in the novel. The conch is used throughout the novel Lord of the Flies to symbolize law and order of the adult world which the boys try to recreate. "The conch. I got the right to speak." (p 45,Piggy) this was a rule made by the boys to keep order. " The conch exploded into a thousand white fragments and ceased to exist" (p200, narrator). Near the end of the novel jack and his group go against the rules and once the conch is broken there is no hope for recovery. "There isn't a tribe for you anymore! The conch is gone."(p201, Jack), and Ralph lose...

In Favor of Lowering the Drinking Age to 18 :: Argumentative Persuasive Essays

Problem: A person should be able to drink legally at the age of eighteen. The law that states that it is legal for a person to drink at the age of twenty-one should be changed so that an eighteen-year-old would be allowed to drink alcohol legally. At 18, you are now an adult and you are expected to act that way. Legally you can vote, get married, buy a lottery ticket, serve in the military and be tried as an adult in the United States court system. These are very important responsibilities that are yours to take care of when you become an adult. â€Å"Good grief†¦let them [also] take the responsibility for the consumption of an adult beverage† (Conway 2000). Solutions: In order to lower the drinking age from 21 to 18, I would: 1)  Ã‚  Ã‚  Ã‚  Ã‚  Find laws in other states and countries as examples. We should look to the European countries as an example to solve our problems in the United States. â€Å"The Europeans teach their children to respect [alcohol] from an early age† (Conway 2000). Theses countries do not have the minimum age of consumption at 21 and this has been proven to make a difference. There is less underage drinking because drinking is part of their culture and lifestyle. It starts in the household with their family and they are taught to drink smart and socially. Social drinking is acceptable; it is a time to have fun while still being in control. New Zealand changed their legal age to 18 in 1989. The slogan â€Å"You’re not just a teen when you’re 18† shows that the New Zealand government is taking the change very seriously and so should the men and women that are of the legal age. Maybe the United States should look around the world to try and solve our own problems. â€Å"Isn’t it ironic that the United States has the highest minimum drinking age and for some strange reason the largest problem with underage consumption† (Toomey & Rosenfeld, 1996)? This statement in itself should be one very good point when considering the change of the legal age to 18. 2)  Ã‚  Ã‚  Ã‚  Ã‚  Alcohol Consumption among minors:   Ã‚  Ã‚  Ã‚  Ã‚  Some might look at this report and argue that at least the amount of alcohol consumption is decreasing among young people since the drinking age has been increased, but what most don’t know is that this has actually been occurring since about 1980. This was long before the states were required to raise the drinking age.

Patterns In Medicinal Advertising :: essays research papers

One of the most innovative trends in print advertising is medicine advertisement. The content of these particular advertisements (ads) are intriguing to me. I intend to analyze five medicinal ads to find the tools used by advertisers and to explore the positive and negative aspects of advertising medicine through print ads for the public. The people who develop ads to market prescription medicine products must have an inkling of what the reader wants to see. For instance, the ads in a parenting magazine most often target mothers. The ads in a sports magazine predominately target athletes. How do the advertisers know what the reader will respond to? Patterns are tools that help us to narrow our thinking down and put thoughts into categories that we identify with. Patterns allow us to store information in blocks so that we do not have to relearn information that has already been learned. Some patterns are universal and most people have some categories or patterns that other people have. An example of a universal human pattern is using language to communicate. Other patterns that we have, may be derived from our own experience and unlike those of others. Patterns are useful in advertising because advertisers can target their reader by tapping into specific categories. Perception is a person's understanding of the information they receive. Depending on their experience or their understanding they will categorize their perception and in turn it will become a thought pattern. For instance when a person talks to a priest their perception of him may be that he is perfect or does not sin. They may categorize all priests this way and not judge them in the way that they would any person who is not a priest. I feel that patterns and perception work hand in hand. Sometimes patterns are formed based on perception, sometimes perception is based on a pattern. What came first the chicken or the egg? I'm not quite sure, but I do know they affect each other. Ads are designed by using patterns that target a specific audience. The reader's perception of the product may form exclusively based on the ad. The patterns that I noticed specifically amongst the five medicine ads that I've chosen to analyze is the break through effect. In one ad there was a woman with her child and they were breaking through glass. Another ad featured a woman and her child with clear blue skies breaking through the clouds above.

Capital Punishment in the Bahamas

Section Capital Punishment The Bahamas hanged 50 men since 1929 according to records kept at Her Majesty’s Prison. Five were hanged under the Ingraham administration; 13 were hanged under the Pindling government, and 32 inmates were executed between 1929 and 1967. The last act of capital punishment in The Bahamas took place on January 6, 2000 when convicted murderer David Mitchel was executed by hanging.Mitchel was convicted of stabbing two German tourists to death. (Nassau Guardian, published: August 27, 2012) A report released by the Inter-American Commission on Human Rights (IACHR) encourages The Bahamas and other members of the Caribbean which maintain the death penalty to impose a moratorium on execution. The IACHR also urged The Bahamas to ratify the protocols of the American Convention on Human Rights in abolishing or reintroduce its application.In 2006 the Privy Council ruling determined that the mandatory death sentence was unconstitutional in The Bahamas. Because of this many inmates at Her Majesty’s Prison who were previously under the death penalty had their sentence commuted to life in prison, received other sentences or had their sentences overturned on appeal. Some inmates had been under the death sentence since the 1990s.In 2011, Parliament passed a law that outlines the categories of murder and states which would have the death penalty attached. The Privy Council ruled that the worst cases of murder is carefully planned and carried out in furtherance of another crime, such as robbery, rape, drug smuggling, human struggling, kidnapping, preventing witnesses from testifying, serial killing, as well as the killing of innocents â€Å"for the gratification of base desires†. (Nassau Guardian, published June 21, 2011)

Explain the Post 16 Options for Young and Adults

Explain the post 16 options for young people and adults Once a young person finishes year 11 they have different options available to them they can choose to go on to further education this can be either within the school in the sixth form or they could go to college. The qualifications that can be gained through further education are:AS and A levels- are full time courses studying mainly academic subjects but also some work related subjects and are generally taken over 2 years. Diplomas- are when the student is still based in their school or college but they have the chance to learn in other settings such as the work place or a college giving them a taste of what to expect in that particular occupation.Key skills- these are designed to prepare students for the working environment and are usually run alongside or are included in other courses although are available on their own. Other options are: Apprenticeships-a more hands on role, learning through work in an apprenticeship where they gain qualifications while working within the job position, with this option they can gain valuable hands on experience, training as well as gaining a qualification while earning a wage at the same time.BTEC’s- are usually studied at school or college they are work based qualifications that are a mix between practical and theory and some work experience.NVQ’s- these can be taken either at school/college, through a placement or in the work place. They are based on the students skills,knowledge and their competence of doing the job.Explain the post 16 options for young people and adults:It's easy to figure out. A lot these kids were pampered, chauffeured, over protected, over parented and just plain spoiled. They also have a tremendous sense of entitlement. Hell, getting a car at age 16 has become a rite of passage! I have friends who regularly allowed their kids boy and girl friends to â€Å"sleep over†, now that's crazy. There are millions of unfilled jobs i n the USA but people (young and old) are fearful of pulling up and moving to where the work is. My parents gave us this advice ‘Get an education, Get a skill, and Get Out† They did all that working class folks could do to help us. Then we were on our own. Simple. To their extreme credit, they paid extra taxes so we could have excellent schools, Many school activities, and anything else we needed to get a good start. ( remember Drivers Ed, at school?) The draft helped too. The war was terrible, but most of us, who served, are better for it. Our generation abandoned this commitment to education and service and became â€Å"the most selfish generation†. Selfishness is not a very good trait to pass on. So now the folks who are still strapped with their older kids are paying, and paying. God bless you, and kick your kids out.