College View Nursing home is a purpose built nursing home located in landscaped gardens on an elevated site within the Cavan town opposite St Patrick’s College on the Clones Road. The centre is registered to accommodate a maximum of 70 residents, both males and females, over the age of 18 years on a long term and short stay, respite and convalescence basis. The centre provides care for a wide range of age related conditions such as general nursing care for elderly residents, Old Age Psychiatry, dementia specific care, respite care, post operative care and palliative care. The nursing home is a single storey facility (1 bedroom located upstairs) and residents are accommodated in 62 single bedrooms and 4 twin rooms with their own en-suite bathroom facility. The town can be accessed by wide
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Comprehensive nursing assessments were carried out that incorporated the use of validated assessment tools for issues such as risk of falling, risk of developing pressure sores and for the risk of malnutrition. Care plans were developed for issues identified on assessment. However, some further work is required to detail the level of confusion or cognitive impairment and how it impacts on daily life for the resident. Information such as who the resident still recognises or what activities could still be undertaken. Residents had personal profiles developed with details of their life history, their likes and dislikes, interest and hobbies. However, this information was not reflected or linked into care plans for social or responsive behaviours. Residents physical care needs were
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The provider employs a whole-time equivalent of 12 registered and 34 care assistants. In addition, there is seven catering and eight housekeeping whole time equivalent employed There are full time staff assigned to the laundry role of activity coordinators. There was an adequate complement of nursing and care staff on each work shift. Staff had the proper skills and experience to meet the assessed needs of residents at the time of this inspection taking account of the purpose and size of the designated centre. The inspector noted that the planned staff rota matched the staffing levels on duty. The supervision arrangements and skill mix of staff was suitable to meet the needs of residents.
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The policy of the centre is all residents are for resuscitation unless documented otherwise. The end of life plans included discussions in relation to life sustaining treatments. Residents were consulted regarding their future healthcare interventions, personal choices and wishes in the event that they became seriously ill and were unable to speak for themselves. A multi disciplinary approach was undertaken to include the resident where possible, their representative, the GP and the nursing team. End of life care plans were reviewed at required intervals. However, residents with a do not resuscitate (DNR) status in place did not have the (DNR) status regularly reviewed to assess the validity of clinical the judgement on an ongoing basis. In medical files reviewed one resident’s (DNR) status was not reviewed since February 2014.
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The inspector found there was an adequate complement of nursing and care staff with the proper skills and experience at the time of this inspection. Staff had access to ongoing education and a range of training was provided during the past year. A total of 14 Outcomes were inspected. The inspector judged two Outcomes as moderately non compliant. These included Health, Safety and Risk Management and Health and Social Care Needs. Seven Outcomes were judged as compliant with the Regulations and a further five as substantially in compliance with the Regulations. The areas of moderate non compliance primarily related to;
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Results: Findings indicate cultural patterns regarding nurses ’ somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses ’ actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients ’ health and ensure wellbeing – individualized care, nurse-patient relationships and caring – which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses ’ perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses ’ work, and avoid placing demands on nurses. Findings were categorized into three main areas: “ Rigid organizational systems complicating nursing care at the expense of caring for patients ” , “ Having the patient ’ s health and wellbeing at heart ” and “ Compensating for a flawed system ” . Conclusions: Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of “ gaming the system ” for caring purposes, in order to ensure the best possible care for patients.
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The American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) surgical risk calculator (American College of Physicians n.d.), released in 2013 (Bilimoria et al. 2013), was developed using data from more than 1.4 million patients, encompassing 1557 unique Current Procedural Terminology (CPT) codes. Patient-related preoperative variables include age, sex, functional status, American Society of Anesthesiologists (ASA) classification, steroid use for chronic conditions, ascites within 30 days prior to surgery, systemic sepsis within 48 h prior to surgery, ventilator dependency, dis- seminated cancer, diabetes (DM), hypertension (HTN), congestive heart failure 30 days prior to surgery, dys- pnea, current smoker within 1 year, history of severe chronic obstructive pulmonary disease (COPD), dialysis, acute renal failure, and body mass index (BMI). The cal- culator also takes into account the type of surgery, based on specific CPT codes and emergency status (American College of Physicians n.d.). Although the NSQIP surgical risk calculator demonstrated excellent performance in predicting postoperative mortality (c-statistic = 0.944), morbidity (c-statistic = 0.816), and six surgical complica- tions (c-statistics > 0.8), it was not developed specifically for use in the older patient population, which is rapidly growing in the USA and is known to have worse surgical outcomes than younger patients (Sukharamwala et al. 2012; Raats et al. 2015; Bentrem et al. 2009). Specifically, the NSQIP surgical risk calculator does not include fac- tors such as frailty and mobility that are known to be important predictors of surgical outcomes in older pa- tients (Kim et al. 2016; Makary et al. 2010).
Askin Asan (2007) the purpose of the research project was to determine the effects of incorporating concept mapping on the achievement of fifth grade students in science class. The study was conducted with twenty-three students at an elementary school Turkey. The students were tested with format prepared by teachers. After pretest the control group was given traditional oral view and experimental group exposed to computer based concept mapping tool. Test score were analyzed and found concept mapping had a noticeable impact on student achievement in science class.
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In some cases hospitalizations seem to be necessary, albeit examinations or treatments could also be done in an ambulatory setting. This might be due to the patient ’ s comorbidities, which do not allow an ambulatory treat- ment (because further monitoring is needed) or because multiple examinations are necessary, which cannot be accomplished by the patient in an ambulatory setting due to his mental and physical state. Another reason mentioned in the interviews is that, in the case of dehy- dration, intravenous fluid replacement is only possible in the hospital and is preferred to the subcutaneous fluid replacement possible in the nursing home. In case of ex- aminations (like x-rays after a fall), which can possibly lead directly to further treatment needs (for example an operation), it is easier and cheaper to conduct them dir- ectly in the hospital. In other cases, patients with de- mentia are sometimes not so easy to handle (causing problems with their safe transportation or waiting times in ambulatory settings), so that transporting the patient in an ambulance and examining them in a hospital seem to be the easiest way to handle their health problems.
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Whether the nursing home can timely treat the dis- ease has a great impact on the satisfaction of the el- derly. The satisfaction rate for the nursing home that can timely treat the disease (97.4%) is significantly higher than that of the nursing home which fails to timely treat the disease (40.0%), with a significant difference (P <0.05). The survey finds that, when the elderly catch a cold or fever-like illness, most of the nursing homes can provide timely medical services; but when the elderly suffer from large and severe ill- ness, individual nursing homes can timely notify the families of the elderly to avoid delay treatment and also maintain a long-term cooperation with the hospi- tals so that it is not only convenient for timely treat- ment of the elderly, but also conducive to good health of the elderly. The interview finds that, the ideal later life of the elderly includes good health, filial children and comfortable life. Thus, the improvement of the medical facilities in the nursing home occupies a piv- otal position in the life of the elderly. Meanwhile, more attention shall be given to the subjective health feeling of the elderly to increase awareness of com- mon diseases and diseases suffered by the elderly, so as to help the elderly treat the disease with an objec- tive and mild mentality.
All articles discussing the psychometric properties of NPI from 1995 to 2013 were searched in Medline via Ovid using “Neuropsychiatric Inventory” or “NPI” and “psychometric properties” as keywords. Twenty-one papers were found after removing duplicates. “Neuropsychiatric Inventory- Questionnaire” or “NPI-Questionnaire” or “NPI-Q” and “psychometric properties” were then searched using the same strategy. Thirteen articles were found after removing duplicates. Last, a search using “Neuropsychiatric Inventory- Nursing Home” or “NPI-NH” and “psychometric proper- ties” as keywords for the same period found 14 papers after removing duplicates. The abstracts of these papers were read to see if they were relevant to the purpose of this paper. If deemed appropriate, a full paper was then obtained. Appro- priateness was defined as those papers that discussed the tool itself, not merely mentioning it briefly as part of a battery of assessment tools. Because this paper is not a systematic review, the search strategies were only conducted to ensure that the author had read as much as possible about the topic before conducting a critical review of the tool. The reference list of relevant papers was also examined in order not to miss any paper on the topic. In the process of writing up the manuscript, the author also searched for more papers using “factor structure” as the keyword search for NPI-related pub- lications in order to better understand how studies reported the NPI’s factor structure. One hundred and one papers were found after removing duplicates. Again, the abstracts were read to determine whether they were useful to the discussion before obtaining the full paper. All relevant papers obtained about NPI’s factor structure were carefully read in full and are included in Table 1.
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Increasingly, care homes are taking on a complex role within the wider health system, catering for the diver- sities of an ageing population that can no longer live in the community. At one end of the spectrum, care homes are acting as proxy hospices for short-stay residents ap- proaching end of life. At the other end, care homes are accommodating residents with cognitive impairments who may survive for many years post-admission. Sup- porting care homes in negotiating these two roles; deliv- ering palliative care for short-stay residents while simultaneously providing a residential home for long- stay residents, in the same space, is imperative and re- quires further research. In addition, further thought should be given to the suitability of care homes in cater- ing for such a wide variation in needs. The potential for other types of services, such as specialist dementia care units and assisted living facilities, in providing care for subgroups of care home residents could be examined, although there is debate as to whether such services provide better care [43, 44].
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The family is ‘‘a unit where the interaction of persons occurs’’ (Walsh, 2007). Hence, the relationship paths between mother, father, caregivers and children, all are straight or accidental (arbitrate or fair). Straight effect can be between the caregiver and the child interactions. In many situations the type of injury will be directly related to the caregivers’ inability to maintain day to day caring activities at home like supervision during play and bathing of the child. Indirect effects include those directed through a caregiver; the demands of caring for the injured child may lead to lack of attention to other members of the family. According to the HBM, all human beings will perform a behavior when they themselves understand the benefit of the behavior to their satisfaction (Assari, 2011). Frameworks for Planning an Injury Prevention Program Planning an intervention on injury prevention is seeking the attention in recent years. Ineffective planning is the major reason for the poor injury control and low health promotion activities in the early times (Howat, Jones, Hall, Cross, & Stevenson, 1997). This in turn leads to provide lot of attention for different models in injury prevention models.
Part of each nursing home’s ‘personality’ encompassed conformity expressed as ‘Every nursing home is like all other nursing homes’. Even though residents accepted standardized care and some residents were comfortable with common routines in the nursing homes, it is neces- sary to point out that residents should not be respon- sible for creating a healthy environment for themselves by adapting to existing organizational culture. Designing nursing homes as conforming organizations might be the reason why, in the same nursing home, residents perceived the day as busy or boring, meaningful or dev- astating. Standardized care illuminated a corporate cul- ture where nursing home residents are seen as merely subject to the culture rather than part of the nursing home culture. Institutional rules, procedures, and envir- onment, and a high degree of conformity to corporate culture can be obstacles to achieving quality of care [4, 31, 32]. However, an area for discussion could be to what degree the ‘personality’ can be changed to close the gap between nursing home corporate cul- ture and residents’ perception of what is important for quality of care. A study found that residents are customized to organizational practices and feel they have little possibility of challenging these practices . In addition, it is important to recognize the basic human right to be treated equally, although, in some instances this means treating residents differ- ently based on differences in their needs and prefer- ences. The distinction between ‘equality’ and
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Arrangements were in place for the prevention and containment of fire. All bedroom doors were fitted with self closing devices and suitable fire fighting equipment was provided including fire extinguishers, smoke detector alarms, emergency lighting and alarm equipment. There were service records of the equipment maintained that confirmed regular servicing took place and they were in good working order. All fire exits were unobstructed and records were read of the daily checks completed nursing staff.
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arrangements in the local area. The inspector reviewed a sample of files and found that GP's called frequently to the centre to reviewed residents’ health care needs. A range of health care services was available to residents, including speech and language therapy, dietetic services, chiropody, optical services and psychiatry services as required. The inspector reviewed residents’ records and found that residents had been referred to these services and results of appointments were written up in the residents’ notes. The nursing notes were recorded every day and night.
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Nursing staff had worked to improve developing the care plans for residents with dementia or cognitive impairment since the last inspection. The majority of the care plans reviewed described well who the resident still recognised and the activities they could participate in. It was clear where the resident was on their dementia journey. However, further work is required to ensure the same standard of care planning is implemented for all residents in this area.
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There was good evidence of pharmacy input to support the management of residents’ medicines. Documented advice from pharmacy of reviews to guide nursing staff on contraindications and other forms of a drug for those with swallowing difficulty or blood screening for residents on a particular drug over a prolonged timeframe was provided. All medication was dispensed from blister packs. These were delivered to the centre by the pharmacist. On arrival, the prescription sheets from the pharmacist were checked against the blister packs to ensure all orders were correct for each resident.
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Residents with walking aids had to leave their assistive equipment in the corridor outside the dining room. The meals were served from a heated trolley in the corridor. While there was a sufficient number of staff available in each dining room to assist residents, staff in the Willow suite did not have space to comfortably assist residents who required helped. There was not space for staff to sit alongside residents requiring assistance. The desserts were served and placed on the tables prior to some residents having finished their main meal. A dessert trolley could not be brought into the dining room to allow residents view options available due to space restrictions.
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I am, Mrs. K.M.KAMATCHI M.Sc(N), II year student from Vel R.S.Medical College - College of Nursing, Avadi, Chennai. I would like to assess the effectiveness of Information Education communication package on home care management for mothers of children subjected to cardiothoracic surgery. I assure that the responses given by you will be used only for my study purpose and strict confidentiality will be maintained. So please feel free in answering the questions. This will be promoting your welfare. So, I request you to kindly give your full co-operation and willingness.
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