Person-centred Care Essay

Person-centred Care Essay Introduction: Reflective essay on person centred care Modern day Healthcare has increasingly embraced concepts of client-centred practice and empowerment. However, Taylor (2003) posits that existing literature on the subject does not give clear and unambiguous descriptions of the ways by which nurses can empower clients. Nonetheless, nursing practice is inclusive of people from very different backgrounds. In my ward for example, a high proportion of the nurses did not get their initial qualifications and experience in the UK, and my mentor too did not start of as a nurse from the UK. As a result of this, in the absence of well defined guidance for patient empowerment as a practice concept (by regulatory authorities), nurses and other healthcare practitioners will always encounter difficulties in the performance of their duties in recognition of patient empowerment as a concept. The way patient care is manifest in hospitals has evolved over time and now centres around collaborative working with different teams coming together to ensure that client care and outcomes are improved (Hansson et al 2008), (Hewison and Stanton 2003). Working in this way requires that the patient is an inclusive and active partner in his care planning and care delivery. This new way of working has also been emphasised by the government introducing the agenda for patient-centred care and patient empowerment. The Department of Health stipulates that the NHS needs to empower patients more and give them control over their healthcare (DoH 2008) and the World Health Organisation (WHO) also requires that patients are always consulted before any procedure is carried out on them (WHO website). The whole concept of empowering patients may not be new to healthcare practitioners because some healthcare practitioners are known to have spoken about making efforts to carry the clients along in the process of their care delivery (Stewart et al. 2002), but Paterson (2001) claims that some healthcare professionals have also been known to use subtle and covert ways to avoid fully implementing the patient empowerment requirement even at the risk of going against regulation to empower patients. Empowerment has been (in essence) practitioner defined to suit the practitioners. As an example, at the MDT meetings I attended, the patients views were not adequately promoted, and considering the requirements of the patient empowerment agenda, the patient is supposed be in charge of his healthcare. I raised this with my mentor and the ward manager, and recommended that the patient be consulted before, and updated after every meeting that has to do with his care delivery. Acknowledging client empowerment as a way forward and in emphasising the need for this modern way of working, the Prime Minister in a key message in January 2008 said that patients are to be treated as active partners in their care. Brown et al (2006) consider that for care to be client-centred, care delivery must be focused on the client and empower and engage the client to his/her full potential as a partner in his/her care delivery. Whereas the client-centred concept requires that what is best for the patient is done, patient empowerment requires providing clients with adequate information and the knowledge required to make informed decisions and take control of their lives (Kielhofner 2002). The issue of patient empowerment raises an issue about empowering intellectually disabled persons who cannot make suc h decisions on their own. If an adult with intellectual disability does not have complete ability to communicate, their choices can be diminished which in turn can make it particularly difficult to ensure that their opinions are heard (Cameron and Murphy 2002); and even in instances where a nurse is designated the health facilitator for the client, there is no guidance as to how much decision making can be undertaken on his behalf (Martin and Carey 2009). These further complicate issues in nursing management for a qualified nurse and will call on good managerial skills. Modern healthcare practice environment is a highly regulated one with stringent requirements of the healthcare practitioners. The continued drive for improvement in both healthcare delivery service and the patients experience and quality of life (DoH 2005) have led to the promotion of improved integration between healthcare disciplines and agencies, and regulatory requirements to promote the concept of patient empowe rment (DoH 2008), (Corsello and Tinkelman 2008), (Glasby and Parker 2008). Empowerment is a natural phenomenon and is essential to humans. Patient empowerment may be resisted by nurses because of existing nurse-patient relationships (Nyatanga and Dann 2002) and so a deliberate cultural shift needs to be pursued to inculcate nurses with the shift in paradigm. To achieve, the nurse will need additional training, and the clients ought to be carried along in drawing up treatment plans. The more the client is involved in the treatment planning, the more the client appreciates his/her part in the patient empowerment agenda, and the more the satisfaction with the care delivery service. I have used simple courtesies like saying thank you to the client, and realised it brightens their day very much and also makes them much happier and willing to discuss their feelings and opinions with me. The convergence of management and nursing has evolved over the past few decades and management is often cited as the reason for failings, and also as the likely solution (Pollitt 1993) to many of the problems in the NHS. Management was first f ormally defined by Henry Fayol (1949) as the composite function of planning, organizing, coordinating, commanding and controlling activities or events. More recent definitions in management theory look at management from the perspective of empowerment, total quality management, organizational culture etc. (Hewison and Stanton 2003). Leadership and management skills in nursing overlap to a very large extent but whereas leadership skills are needed in the more personal aspects like mentoring and motivation, management skills are needed to meet organizational targets and the management of available resources. Summary With the problems associated with recruitment and retention of nurses in the health sector, and the attendant high turnover of nurses came an additional expectation of nurse-managers to help reverse the trend (even though several of the pioneering nurse-managers had not had formal managerial training) (Contino 2004). Contino (2004) described the managerial skills required of a good nurse manager to include change management, communicating plans, managing the flow of information, managing nursing ROTAs and managing finances (income and expenses). Courtney et al (2002) rate financial management knowledge as one of the top requirements for a nurse manager in order to understand financial forecasts, financial plans, financial ratios and financial performance ratios. A nurse manager needs to be very conversant with current practices and concepts. A good understanding of service improvement and knowledge (and use) of the available developmental resources for nurse improvement like the Lead ership at Point of Care programme (Janes and Mullan 2007) are essential for successful nurse-management. Carney (2009) reported that clients were more likely to be dissatisfied whenever they felt the nurse leader was incompetent. The Nursing and Midwifery Council (NMC) requires that the nurse is conversant with and aware of current developments in practice by way of continued professional development after qualifying as a trained nurse. To manage a team well, a nurse will need very good communication skills in addition to the authority to take decisions within the boundaries of his/her responsibility (Cross and Prusak 2002), (Carroll 2005) as and when necessary. A nurse manager should be a good team-player and able to multi-task (Jaynelle and Stichler 2006) and possess very good communication skills that go beyond language and/or grammar, to listening, being assertive and ensuring that the nurses decisions are enforced especially when the nurse speaks on behalf of a client (or helps to amplify the clients voice) (Harris 2003). The nurse manager should ensure that adequate communication links are established between the client and the MDT so that client views are always considered. The nurse manager should patiently try to clearly understand the patient (Lynden 2006) so as to be able to ensure clients views are accommodated in clients care delivery. In situations of acute ailments, clients can present with intellectual disability or a moderated ability to communicate verbally which can make it difficult to understand their opinions or wishes (Cameron and Murphy 2002) for their care process. To be a leader, todays nurse will need to be able to command the respect of other team members. To achieve acceptability nurse managers need to be people with high integrity and people management/motivation skills and be able to work in a collaborative setting (Carroll 2005). Integrity in this perspective is synonymous with honesty (Kouzes and Posner 2002) and several studies have highlighted the importance of honesty fo r nurse management or leadership because people (clients and nurses alike) will want to assure themselves that their leader is worthy of their trust (Kouzes and Posner 2003). During my placements in an adult care unit of a major hospital, from observation and interaction with patients and healthcare staff, my attention was drawn to a plight of some of the patients in my care: I realised that some of the patients were not being allowed to determine the course of their treatment as required by the patient empowerment agenda (DoH 2008) and this was more especial in patients with acute ailments. There was a lack of full management implementation of the Patient empowerment agenda, with particular emphasis on the relevance given to the patients choice (or voice) in the patients care delivery. The quality of care delivery is assessed by its ability to improve patient care through the collaborative team work of healthcare professionals and how patient-focused the care delivery is. For the purposes of this work, I shall refer to a renal patient in my care during my placement as Mr. B (not real name). All references to him or a hospital do not identify either. When Mr. B was †¦ and was refusing to be compliant, I approached him and had a talk with him. I discovered that his lack of compliance was in protest of the fact that he was not aware he was being put on †¦ reinforcing the position of Corsello and Tinkelman (2008) that clients will respond better to care that encourages their participation and is considerate of their specific needs. To ensure that this did not happ en again, I brought the patients complaint to the attention of my mentor and ensured that the multi-disciplinary team was made aware by adequately documenting my findings and observations. I regularly sought advice and guidance from my mentor because mentoring and role-modeling are active ways of knowledge transfer in large organizations (Carney 2009) and improves the care delivery service. Service improvement remains a core requirement for the Knowledge and Skills Framework for a registered nurse (DoH 2004) and requires an all-party embracing culture of seeking continuous improvement (Janes and Mullan 2007) where honest and periodic performance appraisals are evident. Service improvement in the NHS has been an issue of high importance and has necessitated the establishment of groups that are charged with charting out improvements within the NHS like the NHS Improvement (NHS Improvement Programme 2008). Practicing nurses are encouraged to keep abreast with developments from such groups. A new service improvement concept of patient-safety is gaining popularity in healthcare although regulatory definition is not yet specific (Feng et al 2008). Flin and Yule (2003) claim patients can be injured through the actions of healthcare staff, and Feng et al (2008) insist that a blame and shame culture inhibits learning from mistakes and can exacerbate incidences of mistakes. To this end (in the UK) an Expert group was established that recommended that the culture around error reporting shifted towards finding the cause of the error rather than the culprit (DoH 2000). Nurses are often under pressure from shortage of nursing staff, and a change in the nursing environment can improve patient safety and outcomes (Lin and Liang 2007). During my placements, I observed that Mr. B was often in bed for prolonged periods between nursing visits. I appraised the risk of the situation and ranked his needs by priority. He looked like he was beginning to get sore from immobility, so I delegated his need for exercise to the physiotherapist in the MDT, and having assessed the competency level of the HCA on the ward, I delegated the tasks of keeping Mr. Bs environment clean and regularly turning him to air his back to the HCA. The HCA had been previously supervised for this task and had been assessed as competent to perform it satisfactorily. Conclusion To achieve the required improvements which accompany patient empowerment that the NHS strives for, there must be a change from the current culture where the nurse sees the client as a patient (Nyatanga and Dann 2002) towards seeing clients as part and parcel of the decision making in their care delivery. Quality will be improved when patient empowerment/voice in patient care is active, client engagement is on a regular basis, and nurses are more patient in hearing patients out and in attending to patient calls. Patient safety issues including the security of the patient, proper risk assessment, maintaining cleanliness of his environment and regular visits should be the norm

Merits and Demerits of Police Identification

?Discuss any four types of police identification parade emphasizing on their respective merits and short comings. Police identification parade can be referred to as a situation whereby suspects believed to have committed a crime are presented or lined-up for witnesses to identify if indeed the one or group of persons who committed the crime is amongst the line-up. This method is used inorder to help the police confirm if indeed suspect did commit the crime. There are several ways in which police identification parades can be conducted.Depending on the type of situation and resources available for use; be it human or technological will most preferably assist the police on what methods to put in (type of identification parade). When police forces are carrying out their functions, they also have a duty to have regard to the need to eliminate unlawful discrimination, harassment and victimisation and to take steps to foster good relations. The main focus of my study is to address only fou r of these identification parades and analyze into detail their main objectives and discuss their merits and where they fall short.Some of the identification parades we know of may weigh in different levels with regards to effectiveness. Others are judged to be more effective whiles some others are least effective. In this code, identification by an eye-witness arises when a witness who has seen the offender committing the crime and is given an opportunity to identify a person suspected of involvement in the offence in a video identification or similar procedure. From a legal point of view the question that an identification parade attempts to answer is whether the suspect is in fact the culprit.First of all, I would like to discuss about the ‘video identification’. With this method, suspects are kept in a confined area or room under a surveillance camera. A ‘video identification’ is when the witness is shown moving images of a known suspect, together with similar images of others who resemble the suspect. Sometimes in absence of the videos photographs of assumed suspects are shown to the witness to help identify the culprit. Even though it is sometimes useful, it is not the best since it shows still-life images which shows only one sided angle on the view of things and thereby makes it difficult for identification.The video is more advantageous in suspect identification because since there are moving images and gives different angles on the view of things. Examples are; the different kinds of expressions and mood swings exhibited by, the witness can easily identify the suspect if indeed he o she is part. These eye-witness identification procedures are designed to test an eye witness’ ability to identify suspects and to provide safeguards against mistaken identity. Secondly, the identification parade that will be considered here is the ‘line-up’.With this procedure, suspects are arranged or lined up for witnesses t o view and see which of them are or is the culprit. Here, the police officer in charge instructs the suspects to turn to whichever direction the witness asks. The witness is therefore asked to point out to the real culprit(s) who indeed committed the crime. Since this is an open parade, things could get complicated and physical in the sense that, if the witness pin points the suspect, and tempers are not calm, the suspect might step forward and harass the witness physically.In some cases, witnesses might be forced to give false data when they stare directly into faces of the suspects. Some suspects make facial expressions which are very threatening to witnesses and therefore conclude that the witness is not part of the parade for fear for their life. In other cases too, the witness might point to the wrong person who also has an appearance like that of a criminal (shabbily dressed, muscular, bony face, black lips) . Also depending on the type of question the witness is asked, he or she might give false information.Example: if the police asks; â€Å"which of them attacked you or committed the offence? † the witness is implied to just chose a suspect even if, the real culprit is not among the parade. Such questions are imperatives which do not really ask a direct question but instead expects you to comply or conform. Apart from this method shortcoming, there is no doubt that it’s sometimes reliable. Thirdly, identifications can be carried out by using a one-way mirror which is a better procedure as compared to that of the open line-ups.With this method, suspects are lined up in a room which is much secured with glass windows from which the witness can have a clear view of all the suspects present. The windows here are made of glass which are tinted, so suspects do not see whatever that goes on outside but the witness who is outside the room sees all that goes on inside. Identification of culprit(s) becomes difficult for the witness if suspects are dressed in almost the same way and there is the chance that, there exist some similarities between any of the suspects, especially when the culprit is involved.Also not all eye witness’ have very good memeory when it comes to facial recognition. Furthermore, there is the sort of identification which has to do with verbal recognition. Here, different set of audio recordings of different suspects are selected and then played for the witness to identify the culprit. This method is only used in critical situations where the witness did not see the suspect but heard the person speak. This could be difficult for the witness to identify especially when the tapes been played are similar.Sometimes too, the suspect is kept in a confined room with a recording device and is asked by the police to mention specific words suggested by the witness. These words are sometimes the ones the witness heard the suspect say at the time of the incident. In conclusion to the above procedures, the poli ce force can put in severe measures that could enhance or yield positive and effective results to make their work much easier and simpler. There are also instances whereby two or more procedures of identification are incorporated into one to help solve cases which are very delicate and special.

Beethovens Seventh Symphony Analysis - 2490 Words

Symphony No. 7 in A Major (Op. 92), completed in 1812, might have been one of Ludwig Van Beethoven’s most popular pieces. The seventh of Beethoven’s nine symphonies, its premiere concert (December 1813 in Vienna) was performed at a charity concert in order to benefit the soldiers who had been wounded a few months prior in the battle of Hanau. It was performed three times in ten weeks following its premiere. During the time of the symphony’s premiere, Vienna was still distressed due to being taken over by Napoleon in 1805 and 1809 and yearning for victory; the audience at the premiere seemed to have loved the energy and beauty of the piece. The Seventh Symphony had been dedicated to both Count Moritz von Fries and Russian Empress Elisabeth†¦show more content†¦The Seventh Symphony itself can and has been described in many words and fashions. It’s victorious, moving, energetic, powerful, and full of heart. The piece is known for its rhythmic devices (such as dotted rhythm and repeated rhythmic figures) and the celebratory emotion to it, in which makes listeners want to dance and burst into blissful joy. It involves four movements: 1. Poco sostenuto – Vivace, 2. Allegretto, 3. Presto – Assai meno presto (trio), and 4. Finale, Allegro con brio. The score includes two flutes, two oboes, two clarinets, two bassoons, two horns, two trumpets, two drums (in which are tuned to A and E, except in the scherzo where they are in F and A), and basses. The first movement is in A major, with repeated modulations between C major and F major. The second movement also includes modulations (originally in A minor with switches to A major) and the third movement is in F major. The first movement of Symphony No. 7 is noted for its long ascending scales as well as its applied dominants relative to its C major and F major modulations. The Introduction begins with a short A chord from the full orchestra. After eight bars, the piece has b riefly entered the key of F major already and is now accompanied by scales of two octaves which begin softly, similar to the way a person creeps up and down a staircase. These scales repeat, gradually becoming louder and more extravagant. The third themeShow MoreRelatedEssay Plan. Essay Topic: Beethoven’S Symphony No.6 Is A1829 Words   |  8 PagesEssay plan Essay topic: Beethoven’s Symphony No.6 is a turning point in music history Introduction: - What is turning point in music history? Turning point is defined as â€Å"a point at which a notable or decisive change takes place; critical point;† , and it â€Å"represents a lasting shift in the zeitgeist or ‘spirit of the age.’† As an important part of Art, music has a crucial role on representing the human spirit of the age. When a turning point in music history occurs, it implies a change in humanRead MoreThe Impact Of Beethoven On The Development Of The Symphony Until Mahler3555 Words   |  15 Pagesthe development of the symphony until Mahler. Difficult as it may be to define the true relationship of an artist to his successors, this difficulty is enormously increased when the subject is as complex a man and musician as Beethoven. His role as both a â€Å"preserver of the eighteenth-century tradition1 and a pioneer of romantic self-expression, has secured his status as one of the most revered composers in the history of Western music. Throughout his symphonic cycle, Beethoven’s own journey of self-discoveryRead MoreAnalysis Of Adornos Critical Attack On Popular Music1686 Words   |  7 Pagespseudo-individualisation and regressive listening in terms of escapism. Standardisation will be evaluated in structural terms, and critiqued by Middleton (1990) and Witkin (2003). Adorno’s critique of popular music can only be understood in relation to his analysis of serious music, therefore, the essay will focus on both types of music. Adorno’s criticisms of popular music and critics of this criticism, will ena ble for a conclusion to be drawn on whether or not I agree with Adorno’s claims on popular music

What is the Fallacy of Composition

The Fallacy of Composition involves taking attributes of part of an object or class and applying them to the entire object or class. It is similar to the Fallacy of Division but works in reverse. The argument being made is that because every part has some characteristic, then the whole must necessarily also have that characteristic. This is a fallacy because not everything that is true about every part of an object is necessarily true of the whole, much less about the entire class that the object is part of. This is the general form that the Fallacy of Composition takes: 1. All parts (or members) of X have the property P. Thus, X itself has the property P. Explanation and Discussion of the Fallacy of Composition Here are some obvious examples of the Fallacy of Composition: 2. Because the atoms of a penny are not visible to the naked eye, then the penny itself must also not be visible to the naked eye.3. Because all of the components of this car are light and easy to carry, then the car itself must also be light and easy to carry. It is not the case that what is true of the parts cant also be true of the whole. It is possible to make arguments similar to the above which are not fallacious and which have conclusions which follow validly from the premises. Here are some examples: 4. Because the atoms of a penny have mass, then the penny itself must have mass.5. Because all of the components of this car are entirely white, then the car itself must also be entirely white. So why do these arguments work - what is the difference between them and the previous two? Because the Fallacy of Composition is an informal fallacy, you have to look at the content rather than the structure of the argument. When you examine the content, you will find something special about the characteristics being applied. A characteristic can be transferred from the parts to the whole when the existence of that characteristic in the parts is what will cause it to be true of the whole. In #4, the penny itself has mass because the constituent atoms have mass. In #5 the car itself is entirely white because the parts are entirely white. This is an unstated premise in the argument and depends upon our prior knowledge about the world. We know, for example, that while car parts might be lightweight, getting a whole lot together will likely create something that weighs a lot - and weighs too much to carry easily. A car cannot be made light and easy to carry just by having parts which are, individually, themselves light and easy to carry. Similarly, a penny cannot be made invisible just because its atoms are not visible to us. When someone offers an argument like the above, and you are skeptical that it is valid, you need to look very closely at the content of both the premises and the conclusion. You may need to ask that the person demonstrates the necessary connection between an attribute being true of the parts and it also ​being true of the whole. Here are some examples that are a little less obvious than the first two above, but which are just as fallacious: 6. Because each member of this baseball team is the best in the league for their position, then the team itself must also be the best in the league.7. Because cars create less pollution than buses, cars must be less of a pollution problem than buses.8. With a laissez-faire capitalist economic system, each member of society must act in a way that will maximize his or her own economic interests. Thus, society as a whole will achieve the maximum economic advantages. These examples help demonstrate the distinction between formal and informal fallacies. The error isnt recognizable simply by looking at the structure of the arguments being made. Instead, you have to look at the content of the claims. When you do that, you can see that the premises are insufficient to demonstrate the truth of the conclusions. One important thing to note is that the Fallacy of Composition is similar to but distinct from the fallacy of Hasty Generalization. This latter fallacy involves assuming that something is true of an entire class due to an atypical or small sample size. This is different from making such an assumption based on an attribute which is indeed shared by all parts or members. Religion and the Fallacy of Composition Atheists debating science and religion will frequently encounter variations on this fallacy: 9. Because everything in the universe is caused, then the universe itself must also be caused.10. ...it makes more sense that there is an eternal God who always existed than to suppose the universe itself has always existed, because nothing in the universe is eternal. Since no part of it lasts forever, then it is only reasonable that all its parts put together were not there forever either. Even famous philosophers have committed the Fallacy of Composition. Here is an example from Aristotles Nicomachean Ethics: 11. Is he [man] born without a function? Or as eye, hand, foot, and in general each of the parts evidently has a function, may one lay it down that man similarly has a function apart from all these? Here it is argued that, just because the parts (organs) of a person have a higher function, that, therefore, the whole (a person) also has some higher function. But people and their organs are not analogous like that. For example, part of what defines an animals organ is the function it serves - must the whole organism also be defined that way as well? Even if we assume for a moment that it is true that humans do have some higher function, it is not at all clear that functionality is the same as the functionality of their individual organs. Because of this, the term function would be used in multiple ways in the same argument, resulting in the Fallacy of Equivocation.