This paper is a comparative critical review of the literature concerning the problems following discharge directly to a patient's home after intensive care in the hospital ICU.
2,930 words (approx. 11.7 pages), 17 sources, APA, $ 86.95
Abstract This paper compares two articles, both indicating problems after discharge to the home from the ICU, with each other and with an additional review of the literature, "Problems Following Discharge after Intensive Care," written by Daffurn et al (1994) and "Intensive and Critical Nursing Care," written by Scraggs et al (2001). The author points out that the condition, disease, illness, or injury of the patient is most likely one of the two most predominant factors in the experience of the recovering patient upon discharge home from the ICU. The paper stresses the importance of the proper provision of both verbal and written instructions to the patient and the patient's caregiver, since this greatly impacts the patient in terms of well-being, as well as the overall experience of discharge to home from ICU, thus reducing the need for returning to the hospital.
Table of Contents
Objectives
Review of Articles for Comparative Critical Review
Article One
Article Two
Review of Available Literature
Review Comparison and Contrast of Findings
Conclusion
From the Paper "Results of the study found that of the 54 patients 34 of the patients experienced normal sleep patterns after discharge while 15 reported that they were unable to remain asleep due to disturbances and 5 patients were unable to fall asleep. 41 patients reported a normal appetite while 11 reported that their appetite was reduced and 2 patients reported a controlled appetite. Of the 54 patients 17 were not on medications at al while 14 of the patients were n Cardiac medications, 9 patients were taking multiple meds and four patients were taking analgesic medications. In relation to the memory of the patient in relation to the ICU stay 16 of the 54 patients had no memory of the stay whatsoever while 7 had a pleasant recall of the ICU stay and 9 patients claimed an unpleasant recall of their stay in the ICU. Reporting nightmares during the ICU stay were 7 patients while 15 of the patients had complaints of a minor nature. Home support was reported to be "none" by 4 of the 54 patients, while 40 of the patients reported "good" home support and 10 patients reported inability to sleep due to interruptions from home help support."
Examines what constitutes appropriate care when assessing a patient's need for services after being discharged from hospital, with a focus on newborns.
Abstract Discharge planning is a process of assessing a hospital patient's need for care or other services once he or she is discharged from the hospital. The paper shows that the trend toward early discharge of newborns and their mothers grew at such a rate and was accompanied by such serious consequences for some, that the American Congress took note, passing the Newborns' and Mothers' Health Protection' Act of 1996 which allows mothers the option of requesting a longer stay if she feels she and/or her child require it. Despite this act, most women elect the shorter hospital stay. The paper shows that the problem that needs to be addressed, however, is to determine, as precisely as possible, what constitutes effective early discharge planning for newborns and their mothers. The paper delineates effective practices and then applies the obtained information to midwifery concerns and practice.
From the Paper "One of the more interesting findings regarding early discharge planning is that there are some indications that certain factors allow for earlier release than others, and one of these is delivery by a midwife. In this regard, Margolis, Kotelchuck and Chang (1997) examined if mothers discharged from the hospital and one night's stay differed in any ways from mothers discharged after two or three nights stay. Specifically, it was found that mothers whose babies were delivered by midwives were more fit for early discharge than mothers whose babies were not delivered by midwives."
Abstract This paper evaluates hospital discharge procedures. The author cites a number of empirical research studies which look at caregiver and patient attitudes toward discharge practices. The author also discusses the legal, moral and procedural considerations a hospital must take in determining its discharge plan. The paper concludes that while systematization is important, flexibility is also crucial to ensure that the individual patient's needs are met.
From the Paper "There have been a number of studies concerned with the issue of patient discharge practices. Studies on decision making in discharge planning have investigated patient participation (Coulton, Dunkle, Chow, Haug, & Vielhaber, 1988; Coulton, Dunkle, Goode, & MacKintosh, 1982) and social workers' perceptions of patient participation (Abrahamson, 1988). To date, no studies have conceptualized discharge planning as a social process of small-group decision-making by elderly patients, family caregivers, and discharge planners. Participants' perceptions of the process are unknown."
Abstract The paper presents the seven step discharge policy and practice for newborns. It reviews current issues along with a historical perspective in terms of hospital discharge practices for mothers and newborns. The seven step method is expounded upon very thoroughly along with all the factors necessary for implementation.
From the Paper "America has a highly developed health care system, which is available to all the people whether through individual pay or through program affiliation. Although it can be very complex and frustrating at times it has come a long way from the health care organizations of the decades before. Previously most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics. Today the level of health care has excelled tremendously. Presently the goal of our health care is to have a continuum of care for the patient, one which is integrated on all levels. Many hospitals offer a referral service or discharge plan to patients who are being discharged. Plans for the patient are discussed with a discharge planner."
Abstract This paper presents a teaching plan for a patient that is being discharged after dealing with problems regarding the maintenance of skin integrity. A plan of action with expected outcomes is developed for the patient and primary caregivers to follow after being discharged. The plans and expected outcomes are based upon the issues that have caused or may cause impaired skin integrity in the home environment. The paper also includes a hypothetical visit to the home a few weeks following the discharge date. The paper determines whether the patient and caregivers complied with the teaching instructions while adapting back into the home environment.
Outline
Abstract
Introduction
Patient Profile
Development of Problem List
Plan of Action
Identification of Outcomes
Method of Evaluation
Conclusion
From the Paper "Discharge for the care of a patient with the risk for impaired skin integrity is an important aspect. The skin functions by protecting the body from injury, regulating body temperature, noted sensation, metabolism, and provides a use for communication. However, when becoming an older adult the skin ages, losing thickness, elasticity, becomes drier, and has decreased circulation. All of which allow the skin to be at risk for impairment or damage. (Craven & Hirnle, 2003) Patient's at high risk for impaired skin integrity include but are not limited to the elderly, diabetics, poor nutrition, paralysis or impaired mobility. (Thompson, 2003) When planning discharge for the risk of skin impairment, factors that contributing to the risk and optimizing the patient's condition should be taken into consideration. "
Abstract This paper presents a research proposal for showing how an effective hospital-based discharge planning program can reduce the rates of hospital readmission in elderly patients with congestive heart failure (CHF). The paper shows the need for more effective discharge planning programs that will optimally reduce the rate of hospital readmission for elderly patients (clients aged 65 and older) with CHF. The proposal follows a format in which the narrative is put forth, including the problem statement regarding CHF and readmission, research questions that are relevant to these issues, and the background and significance of the issues. The report also includes a limited literature review on the topic, culled from extensive literature available on both effective discharge planning and CHF incidences. The rationale of the study is also addressed, before the report proposal concludes by stating the research methodology that will be chosen for the conducting of actual research, along the lines of having the ultimate goal of improving community health outcomes.
Table of Content
Problem Statement
Research Questions
Background
Literature Review
Rationale
Proposed Methods
From the Paper "At the same time, from this cost-effectiveness standpoint, hospitals must also realize that cutting corners in regards to effective discharge planning, particularly for CHF patients, can mean short-term gains bringing vastly increased future costs. "Hospital admissions among patients with CHF are a major contributor to health care costs...The program's aims were to make up deficits in health care delivery, improve quality of life, and reduce costs for the health insurance companies (e.g., by reducing the hospitalization rate [Stewart, Marley, and Horowitz, 1999; Whellan et al., 2001; Cline et al., 1998])" (Kottmair et al., 2005). Therefore, from either perspective externally, the importance of effective discharge planning for elderly patients with CHF is underscored in the current healthcare environment, to ensure the continued provision of quality care across the lifespan."
Abstract A detailed history of the many ways in which lesbians served in the United States military during World War II. The paper discusses the relaxed policies at the onset of the war that allowed gay women to enlist, the social climate and obstacles of enlisted lesbians, and the gradual implementation of procedures to search out and discharge enlisted lesbians as the war neared its end.
From the Paper "If women's history in the United States is often overshadowed by the history of the male gender, lesbian women's history may very well be looked over altogether. Though existing on the fringes of mainstream society, and not acknowledged in most official records, women and lesbians have had a long, accomplished, patriotic career in the United States military. But World War II was a defining moment for gays and lesbians in uniform. As their community was forming and gaining visibility in civilian life, gays and lesbians in the military were singled out as undesirables for the first time, not because of any sexual acts that were engaged in, but because of the very nature of their orientation. The era prior to the start of World War II had been a tumultuous roller coaster in the political and social history of the United States. Women who had once been politically disenfranchised and relegated to the realm of wives and motherhood, now had the right to vote, an increasing presence in the workforce, and a greater independence from the necessity of marriage and domesticity. Relationships were now not solely dependent on practical needs, but were based on mutual interests, romance, and emotional connections. As advancements had been made for women in their personal lives, so too had they in military service."
Abstract This paper discusses considerations that need to be taken into account by the cruise ship industry. It particularly discusses the Grand Turk Cruise Center. It describes the tourist's role, customer satisfaction and on and off board problems. The paper then discusses potential changes for the future and how these would impact the cruise ship industry.
Table of Contents:
The Grand Turk Cruise Center
"She's Here"
"Full Satisfaction"
Grand Turk Cruise Center
Sampling of Sights Grand Turk's Perks
II. Ideas Regarding Relationships and Environment
The Tourist Role
The Small Caribbean Islands
Stay Away
"What's new?"
Pressure to Grow On
Caribbean Tourism: A Blight or a Blessing?
On and Off Board Problems
Fragile Balances
Discharged Pollutants' Safety Status
Societal Choices
Turtles in the Turks and Caicos Islands
III. Choices for Change
Features from the Present; Traces from the Past; Signs of Future
Artificial Versus Authentic
Stiff Solutions
Hidden Costs
Looking Back for Future Inspiration
From the Paper "Mega-ships regularly dump pollutants illegally. Cruise ships environmentally generate horrific amounts of "sewage, oily bilge water, solid waste, grey water ("down the drain" waste) and hazardous wastes," Roberts states. Waste disposal management, as well as disposal of these wastes is only sometimes enforced and most of the time improperly regulated. International environmental practices are minimal in the industry. Federal and local laws which govern waste discharges into coastal waters have not "teeth." (Roberts)"
"Cruise ships generally transport approximately 2000 passengers. The largest ship can accommodate 5000 individuals, simultaneously sailing in international waters under flags of convenience. Frequently, some crews ignore labor and international maritime standards, utilizing opportunities to abuse labor rights, as well as environmental regulations. (Roberts)"
Abstract The paper looks at the research question of what determines functional gains in the patient who is undergoing rehabilitation following knee arthroplasty. The paper questions whether it is an external treatment or a patient trait which determines effective rehabilitation. The paper critically analyzes two studies that address this question, one a randomized trial and the other a cohort study. The paper compares their strengths and weaknesses and discusses the applicability of the research results to local rehabilitation patients.
Outline:
Study 1 - Randomized Controlled Trial of Hospital Stay and Functional Independence, Post-Discharge Study 2: Influence of Age and Gender on Outcomes with Knee Arthroplasty after Rehabilitation
Comparison of Strengths and Weakness in Both Studies
Applicability of Study Results
From the Paper "Rehabilitation outcomes for patients who have undergone knee arthroplasty may be due to the efficacy of single external treatments given in isolation from other therapies. Such treatments consist of osteopathic manipulative treatment (Licciardone, et al., 2004). However, beneficial outcomes for these patients may depend more on patient characteristics such as gender and age, and on taking these variables into consideration. According to Vincent, et al., 2006), the functional outcomes for knee arthroplasty in rehabilitation programs may be impacted by patient characteristics."
Tags: patient, characteristics, age, gender, variables, discharge, recovery, hip
Abstract This paper discusses the Second Chance Act that was passed in 2008 to address the problem of recidivism. The writer discusses the reasons for this problem and the motivation behind the Second Chance Act, and shows how both are affecting New York in particular. The key stakeholders in this issue in New York are identified, and their roles are explained. An overview is given of what is currently being done in New York regarding this issue, and alternatives that have been advocated under the Second Chance Act are listed. The paper concludes by recommending in-service pre-discharge vocational/educational training for inmates as the most feasible policy for New York and other states to implement.
Outline:
Action Forcing Event
Problem and Organization
Background,Timeline, and Data About the Problem
Environmental Scan/Key Players
Policy Alternatives
Recommended Policy Alternative
From the Paper "By passing the Second Chance Act, Congress has made itself a key play in the issue of recidivism in the United States and at the State level. The passing of this legislation illustrates just how concerned Congress is with this problem and the lengths that they would go to address the problem. Given the structure of the Second Chance Act, it is clear that Congress thought that the best way to address this problem was through the states so they provided the states with the means to address the problem locally, where the released offenders will be forced to return upon release. A total of $55 million dollars was appropriated for the States to address this problem. Congress' ultimate goal was to provide a safe way for the released offenders to transition back into normative society without reengaging in criminal activity."
Abstract Bankruptcy is not an easy process, and the average individual does not possess the knowledge to enter into proceedings on his or her own. The paper argues that professionals should always be consulted as they can determine which bankruptcy is appropriate or whether bankruptcy is necessary at all. The paper also looks at the bankruptcy court, which has been established to protect and assist individuals, companies, and corporations in their proceedings.
Paper Outline
A. Federal Bankruptcy Code
a. Explanation of the Origin
b. Federal Bankruptcy Law
c. Jurisdiction of Courts
B. Chapter 7 Liquidation Bankruptcy
a. Procedure
i. Filing a Petition
ii. Meeting of Creditors
iii. Appointment of Trustee
iv. Proof of Claims
b. Automatic Stay
c. Case Dismissal
d. Alternatives to Chapter 7 Bankruptcy
e. Discharge C. Chapter 11 Reorganization Bankruptcy
a. Why choose Chapter 11
b. Plan of Reorganization
i. Who develops the Plan
ii. Steps in the Plan
c. Discharge D. Chapter 13 Consumer Debt Adjustment
a. Chapter 13 Eligibility
b. Important Features
c. Filing
d. Automatic Stay
e. Plan of Payment
f. Confirmation of the Plan
g. Discharge E. Chapter 13 or Chapter 7
F. Rights of Creditors
G. Conclusion
From the Paper "If you are living with little income and property you may be "judgment proof". Basically creditors cannot collect because you have nothing for them to legally take. Taking advantage of federal and state debt collection laws that protect a debtor from abusive conduct may stop harassment from creditors. Possibly, a debtor may negotiate with creditors and buy enough time to get back on his or her feet. Creditors may also agree to settle debts for less than is owed. Debtors may seek help from outside sources such as Consumer Credit Counseling Service. Finally, a debtor may pay over time with a Chapter 13 proceeding, which will be discussed in a later section."
Abstract The paper first assesses the potential risk to the environment of these chemicals that are industrial dischargers. The writer describes the governmental regulations that have attempted to halt the production and discharge of these chemicals into the water supply. The paper then explains the ways in which the ingestion of these chemicals can harm individuals who unfortunately encounter polluted water supplies.
From the Paper "Centrifugation or filtration is necessary to remove particulate or suspended matter prior to analysis. This method has the advantage of separating and analyzing two or more substances in the event of a mixed spill. Again this method should be combined with mass spectrometry to positively identify the sample. Another method involves the use of infrared spectroscopy for concentrations of 4 to 40 ppm toluene in water. The sample is acidified, extracted, and then scanned in the spectrophotometer. There is minimal sample loss due to volatilization, however, one must know the identity of the compound being analyzed (Norris and Dowd, 1994, 458-462)."
Abstract This paper explains that Minamata Disease, a poisoning disease of the central nervous system caused by methylmercury compound, which is discharged from factory effluent, polluting the environment and then, through the food-chain, accumulated in fish and shellfish. The author points out that, at first the Japanese government denied the relationship of the factory discharge and the illness, putting the needs of the factory above the well-being of its citizens and environment; but in 1969, well after the polluting production process had been shut down, the area was designated a protected marine area by the government, requiring that no waste-water containing methylmercury be released into it. The paper relates that the Japanese government has taken measures to prevent this from happening again; compensation settlements have been reached, and today, the national government is the body that certifies a person as being afflicted by the disorder.
Table of Contents
Introduction
Discovering Minamata Disease
A Deadly Disease
Significant First
Understanding the Disease
Governmental Involvement
Political Settlements
Continuing Lawsuit
The Disease Today
Conclusion
From the Paper "The first case of Minameta Disease was reported in 1956, "in Minamata City located on the Yatsushiro Sea coast in Kumamoto Prefecture, in a patient suffering from neurological symptoms of unknown cause." This case led Minameta City to immediately develop the Committee on Unknown Disease to take measures against the patients and investigate to find the cause. The investigation was conducted mainly by Kumamoto University, and in November 1956, the university reported that the disease is a certain type of heavy metal poisoning transmitted via fish and shellfish. Since knowledge and experience about environmental pollution were not enough at that time and technology for analysis of very small amounts of chemical substances was insufficient, a great deal of time was required until the cause was made clear."
Tags: methylmercury, food-chain, compensation, protection, japan
Abstract This paper evaluates the role of long-term care admissions and discharges on the utilization rates of healthcare services in the elderly population. The writer discusses that it is anticipated that these rates decline for elderly persons upon discharge from these facilities, as patients have improved their overall health outcomes as a result of such stays.
From the Paper "In a long-term care facility, it is necessary to consider the various issues related to the quality of health services and aspects of utilization. The outcomes related to health utilization are based upon a number of contributing factors, many of which are a product of the external environment in which these facilities are located, as well as the type of health systems that operate in these areas. It is anticipated that other important considerations also include cultural boundaries, population statistics, and financial factors, amongst others. Therefore, it is also expected that the utilization of healthcare products and services in the elderly population is largely based upon these factors, and that regular utilization is likely to improve overall health outcomes in this population."
Abstract The paper examines the current situation on the Olifants River and the extent of its pollution. The paper identifies market-based approaches to pollution control and considers the feasibility of applying similar market-based pollution controls in the Olifants River. The paper concludes with the recommendation that market-based pollution controls offer one of the best means of improving the quality of the water resources in the river. The paper appends several photos that require QuickTime and a TIFF (uncompressed) decompressor to view.
Outline:
Introduction
The Situation: Discharge and Pollution in Olifants River
A Solution: Trading Discharge Credits for Pollution Management
Application: Feasibility in the Olifants River Situation
Conclusion and Policy Recommendations
From the Paper "A significant portion of the mining, agricultural, and power generation requirements of South Africa is currently managed with water from the Olifants River. Because of the very real problem of drought in the region, it is crucial that the water resources that available from the river are managed in an effective manner that efficiently distributes the limited resource to as many interests as possible in the highest quality form available. At issue is the matter of pollution of the Olifants River. This has been primarily attributed to runoff from existing and older, disused mines."
