Sunday, January 26, 2020

Healthcare Governance and Management

Healthcare Governance and Management The healthcare organisation is complex and dynamic. This is because its practices are vital because the healthcare systems are increasingly and consistently facing challenges that if they provide no solutions, turmoil happens and lives become significantly affected. Berg, M., Black, G. (2014). Clinical governance and management constitute a necessary framework that aids in the continuum of organisational processes in the pursuit of well-being and health as collective goals. Berends, L. Crinall, K. (2014), Kickbusch, I. Gleicher, D. (2017) and Ross, F. and et al. (2014). Being mindful of the differences between clinical governance and management is crucial. There must be caution and precise boundaries needed to make sure that governance does not become entangled with management. Berends, L. Crinall, K. (2014). The entire concept of separating health care governor (or board) from healthcare manager can be confusing, but a division of duties must be established to clarify responsibilities and roles in the execution of the activities. Brennan, N. M., Flynn, M. A. (2013). To begin with, governing and managing are both influencing from a position of authority. Berends, L. Crinall, K. (2014) and Scott, L., Caress, A. (2005). And this is where governance and management become different governing is more of putting a competent person into a particular position while managing is overseeing the operations. (?) Healthcare governance deals with the big business picture of a health organisation; it is the body which makes the policies by which the management follows to have standards. It is a system by which managing bodies, managers, clinicians and staff share responsibility and accountability for the quality of care, continuously improving, minimising risks and fostering an environment of excellence in care for patients. Gupte, A., Mclntosh, B., Sheppy, B. (2012); Gottwald, M. Landsdown, G. E. (2014); Herd, G., Musaad, S., Herd, G., Musaad, S. A. (2015). Whereas, management provides the day-to-day activities of order and consistency of the organisation by following the management process of planning, organising, staffing, directing, and controlling members to ensure that they remain committed to their obligations. Day, G. E., Leggat, S. G. (2015) and Marquis, B. Huston, C. (2012). Multiple published research literature gave different definitions, yet it has a common idea that both bodies must have the principles of transparency, participation, responsiveness, equity, efficiency and effectivity, sustainability and accountability in improving the quality of services and patient safety.ÂÂ   These principles apply to any organisation whether local such as Lakes District Health Board or national like Ministry of Health. Gauld, R. Horsburgh, S. (2012), Curran, C., Totten, M. (2010) and Laouer, R. (2011). Separated, different, hierarchal or not clinical governance and health care management both define and identify the plans of the organisation as well as implement and put strategies into actions to achieve goals. Kumar, S., Adhish, V. S., Deoki, N. (2014). Although a distinction exists, they share a common goal- about people, and it covers the whole patients journey including the horizontal integration across the different levels of services and sector. Dr. Brown, J. and et al. (2009), Bismark, M. M., and et al. (2013), Gillam, S., & Siriwardena, A. N. (2013) and Blegen, N. E., & Severinsson, E. (2011). Resources: Bader, B. (2008). Distinguishing governance from management. Retrieved from http://www.canterbury.ac.nz/academicservices/documents/Academic%20Administration%20Workshops/Workshop%201/Distinguishing%20Governance%20from%20Management%20-%20Workshop%201.pdf Berends, L. Crinall, K. (2014). Management and Practice in Health and Human services organisations. Victoria, AU: Oxford University Press. p68. Berg, M., Black, G. (2014). A Canadian perspective on clinical governance. Clinical Governance: An International Journal, 19(4), 314-321. doi:10.1108/CGIJ-10-2014-0031 Bismark, M. M., Walter, S. J., Studdert, D. M. (2013). The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria. Australian Health Review, 37(5), 682-687. doi:10.1071/AH13125 Blegen, N. E., Severinsson, E. (2011). Leadership and management in mental health nursing. Journal of Nursing Management, 19(4), 487-497. doi:10.1111/j.1365-2834.2011.01237.x Brennan, N. M., Flynn, M. A. (2013). Differentiating clinical governance, clinical management and clinical practice. Clinical Governance: An international journal, 18(2), 114-131. doi:10.1108/14777271311317909 Curran, C., Totten, M. (2010). Expanding the role of nursing in health care governance. Nursing Economic, 28(1), 44-46. Day, G. E., Leggat, S. G. (2015). Leading and managing health services an Australian perspective. Port Melbourne, AU: Cambridge University Press. p5. Dr. Brown, J. and etal. (2009). Ministerial task group in clinical leadership in good hands transforming clinical governance in New Zealand. Retrieved from http://www.asms.org.nz/wp-content/uploads/2014/08/In-Good-Hands-2009_151202.pdf Gauld, R. Horsburgh, S. (2012). Clinical Governance Assessment Project: Final Report on a National Health Professional Survey and Site Visits to 19 New Zealand DHBs. Dunedin: Centre for Health Systems, University of Otago. Gillam, S., Siriwardena, A. N. (2013). Leadership and management for quality. Quality in Primary Care, 21(4), 253-259. Gottwald, M. Landsdown, G. E. (2014). Clinical Governance Improving the quality of healthcare for patients and service users. New York, NY: Open University Press. p2. Gupte, A., Mclntosh, B., Sheppy, B. (2012). When two worlds collide: Corporate and clinical governance. British Journal of Healthcare Management, 18(12), 619-620. Herd, G., Musaad, S., Herd, G., Musaad, S. A. (2015). Clinical governance and point-of-care testing at health provider level. New Zealand Medical Journal, 128(1417), 41-46. Kickbusch, I. Gleicher, D. (2017). Governance for health in the 21st century. Retrieved from http://www.euro.who.int/en/publications/abstracts/governance-for-health-in-the-21st-century Kumar, S., Adhish, V. S., Deoki, N. (2014). Introduction to Strategic Management and Leadership for Health Professionals. Indian Journal of Community Medicine, 39(1), 13-16. doi:10.4103/0970-0218.126345 Laouer, R. (2011). Physicians in management: a case study of their role in the governance structures in the French hospital boardroom. International Journal of Clinical Leadership, 17(2), 103-109. Lau, R., Cross, W., Moss, C., Campbell, A., De Castro, M., Oxley, V. (2014). Leadership and management skills of general practice nurses: Experience or education?. International Journal of Nursing Practice, 20(6), 655-661. doi:10.1111/ijn.12228 Marquis, B. Huston, C. (2012). Leadership roles and management functions in Nursing. Philadelphia, PA: Lippincott Williams Wilkins. Ross, F., Smith, P., Byng, R., Christian, S., Allan, H., Price, L., Brearley, S. (2014). Learning from people with long-term conditions: New insights for governance in primary healthcare. Health Social Care in The Community, 22(4), 405-416. doi:10.1111/hsc.12097 Scott, L., Caress, A. (2005). Shared governance and shared leadership: Meeting the challenges of implementation. Journal of Nursing Management, 13(1), 4-12. doi:10.1111/j.1365-2834.2004.00455.x

Saturday, January 18, 2020

A Right Against Torture? Essay

Explain how you would try to justify an absolute right against torture, and how you would try to meet the main objections to such a proposed right. This essay sets out to deal with the very important issues raised by the practice of torture in today’s society. More precisely, the point of this paper is to defend a right against torture, of which all people should benefit, and not just any kind of right, but one of an absolute nature. In order to deal with these issues the essay will firstly justify why and absolute right against torture is mandatory from a philosophical point of view as well as a methodological one. Secondly, this essay aims to present its defences and critiques against the main objections to this proposed absolute right. In achieving both goals the paper will present empirical and normative evidence of why people from all over the world should benefit from this absolute right, and not just in writing, but also in practice. Before venturing forth with the arguments necessary to defend the absolute right against torture I will explain the term of ‘absolute right’ as it is needed so that everyone understands the importance of such a right and even more, so that everyone can acknowledge the gravity of infringing upon such a right. An absolute right is a right that cannot be infringed upon under absolutely any circumstances. The right against torture qualifies as such an absolute right under agreements such as the ECHR (European Convention on Human Rights), the UKHRA (UK Harm Reduction Alliance) and the UDHR (Universal Declaration of Human Rights). There are today 192 signatory states of the UDHR; these states are legally bound to respect all of the articles of this document. The main problem is that even though all of these states have signed the declaration, there have been reports between 1997 and 2001 of torture being practiced in 140 countries. It is therefore sad when we come to the conclusion that even though this right is one from which these people should have been protected from, that has not happened and it has not been enforced, but severely infringed upon in many of the states it should be guaranteed. An absolute right against torture as far as I am concerned should not even be defended in any kind of way, but instead it should be implied, it should be a given and it should not be a topic of conversation in any corner of the world. The reasons why I will always try and be a stalwart defender of such a right are many. The two main arguments I would like to propose in order to defend this right are the fact that torture constitutes an incredibly immoral and degrading practice, and that furthermore, torture practised in today’s society will halt, at least on some level, the capability of human beings to progress. The world has evolved from all points of view, today we live in a world that has significantly improved technologically, a world that has seen major improvements in ways of thinking, a world that is now more human rights based than ever, and yet the same world cannot seem to be able to let go of one of the most backwards practices it has ever invented, torture. The status-quo of today’s world is not violence as it was in the Middle Ages, on the contrary, we live in a world that has more and more tried to enhance its defence of human rights and to reduce the as much as possible the unnecessar y use of force, terror and violence against humanity and not only. Perhaps if we had all lived in the Middle Ages, the practice of torture would not seem as appalling as it does to so many people today. I strongly believe that torture is wrong no matter what approach I take. Torture is immoral and fundamentally wrong and it has both short-term and long-term disastrous consequences on all human beings – not just those people it is used against. Although torture has been declared an illegal it has been used many times. This means it happens in an undisclosed manner, people do not really know when and where it happens most of the times, and if they find out it is because some mistakes have been made. With the technological advancements today it is easier to capture and present to the public such acts of violence than it was before. One of the discourses on torture has been on what kind of approach should be taken. The solutions when dealing with torture are as follows: make torture legal and resort to it when needed; never resort to torture no m atter what the circumstances; declare torture illegal and always declare that torture will not be used but resort to practicing it when needed but only ‘under the radar’. The only reasonable approach as far as I am concerned is to never under any circumstances resort to torture. Using a process of elimination this is still the only reasonable opinion in regards to torture as the other two options are immoral. First of all, making torture legal should again require no arguments as to why this is immoral. The arguments are plenty and yet its defences are few if any, but first let us address the arguments against making torture a legal act in any society. This is a case that need be taken in consideration in democratic states and not autocratic ones since in those cases there is no system of checks and balances in place and the state does not answer to its citizens (who are even viewed and treated as mere subjects in some cases). In a democratic society, making torture legal seems a rather impossible task as far as I am concerned. I do not have an actual statistic regarding people’s views on torture and yet I feel confident enough to say that the majority of people would vote against it. Even if that were not the case, people would still need to know what they are voting for. Let us consider a situation where a country would like to make torture legal. The party that would like to propose such a legalization of torture would present its case and try to hide as many realities concerning torture as possible and instil a sense of constant fear into the people, explaining that many deaths would be avoided if they would be allowed to resort to torture procedures and last but not least explain the ‘ticking bomb scenario’ (to which I will come back later) and try to make it seem like a general rule rather than the exception it really is. The opposition would in this case only need to present torture as the immoral, degrading and humiliating practice it is. The best way for this would be to present acts of torture on television so that all the people that were thinking of voting in favour see what torture really is. I find it hard to believe that after such a spectacle anyone would even consider voting in order to pass the legalization of torture. For the sake of the argument let us however consider that the people, even after watching the gruesome shows of torture would still vote on behalf of making torture legal. In that situation, all we need to do is resort to Alan Dershowitz`s argument and ask ourselves whether we really want to create such a society in which someone has a right to torture. We would need to train people in special torture techniques, have companies produce torture equipment, torture rooms would no longer need to be hidden, maybe even build them in the centre of the city with glass walls so that everyone can witness what is happening in there and so even more instil fear in potential terrorists. Children would no longer say they want to be policemen, firemen, astronauts or race car drivers, but torture experts. Institutionalizing torture would lead to an increasingly violen t society, a society where normality would shift towards violence. Today many people believe and adhere to the idea that violence is not the answer; not only people, but entire societies try and uphold this idea of non-violent responses, yet by legalizing the practice of torture we would help build a society where indeed violence would be the answer. Even if no other matters, laws or practices would suffer changes directly with the exception of torture being legal that can arguably lead to a more violent society by constantly being in the minds of people as a regular occurrence. One of the major problems today that need be addressed when taking into consideration the possibility of people agreeing to make torture legal is the fact that people are most of the times concerned mainly about their own wellbeing and are hypocritical. People often judge facts or disregard certain realities because of a ‘what they don`t know won`t hurt them’ mentality. This is why they must be presented with the real humiliating act of torture; they must witnes s it in order to truly appreciate its immoral and degrading nature so that in the end they may be able to cast a vote that truly reflects their thoughts and feelings regarding this matter. This is one of the reasons why we need to have an absolute right against torture, since without it we would live in a slowly morally degrading society that allows for such horrendous acts to happen, a society that sacrifices its morals to gain what it misleadingly believes to be protection against terrorist threats. The second choice when confronted with torture would be for the government to allow for it to happen ‘under the radar’ while publicly organizing fake propaganda against it for the people. This again is very immoral. In order for a government to allow for torture to happen would mean that it is renouncing its liberal and democratic values since it would be doing something it does not have approval from its citizens to do. Torture is in all aspects immoral and should always be considered to be immoral. Torture is immoral because it dehumanizes everyone involved in it. It dehumanizes and degrades the victim, the same victim who is humiliated and treated in a way not even animals should ever be treated. It is immoral because it is an assault on human dignity. Furthermore, torture does not only dehumanize the victim, but the torturer as well. This entire process, even if done ‘under the radar’ or with public support, degrades the society as a whole with its practices and implications. The major pro torture defences are self-defence and the ‘ticking bomb scenario’. A democratic society cannot allow for torture to happen in any of these scenarios, as appealing as they might seem at a first glance. In order to understand why an outright ban should be imposed against torture and an absolute right against it be adopted we need to take a deeper look at what these scenarios bring to the negotiation table. In the self-defence scenario, where someone knows the whereabouts of a person that will die if not helped soon, some people will say that by torturing the person who is withholding the information might get them the location of the person in need of saving. This is again immoral since we`ve seen the very big problems th at come with institutionalizing torture but let`s think beyond that. Why would it ever be right to torture one person in order to save another? Sure, it is self-defence when someone assaults you and you fight back and eventually end up injuring or killing the person that tried to assault you, and it would qualify as self-defence. It would even qualify as self-defence if someone were to hold your wife at gunpoint and you would eventually manage to save her and again injure or kill the attacker because in that situation laws in most countries extend the self-defence to the person that was the victim in the first place. But there is however a difference between someone holding a gun to your loved one`s head, and that same person withholding knowledge as to where the loved one is being held and they might die if not helped in time. The difference between the above mentioned cases lies with the certainty factor and how direct the two possible crimes are. It`s one thing to have a gun held at someone`s head, where you could maybe even see the attacker pull the trigger, while a person held somewhere deprived of air maybe is not a direct ‘trigger’ being pulled; not to mention the fact that when seeing the attacker holding the gun aimed at someone makes you almost certain of their intention, while one can never be sure that the attacker even has information as to the whereabouts of the victim. Even if torture would not be completely immoral and encumbered with so many ‘plagues’ against society, the uncertainty and the level of direct or indirect connection to the crime should be enough to outright ban torture. The ‘ticking bomb scenario’ is arguably the strongest defence of pro torture theorists. For this reason I will address it now and try to explain why this case should not allow torture to happen under any circumstances and even with this scenario in mind an absolute right against torture is needed. The main argument of this scenario is that indeed a terrorist believed to have information about the location of a time bomb that will go off in a crowded place should be tortured in order to find out where the bomb is. I find this scenario quite poor in its convincing capabilities but that is not the case for many people confronted with the idea so the problem requires addressing. This scenario is ultimately used as a trap for liberals that out of principle refuse torture on any kind of basis, be it the case of legalization or of it happening ‘under the radar’. When confronted with this situation some liberals cannot hold back out of principle and beliefs anymore and indeed give in to a hypothetical situation where the torture of one terrorist would save the lives of thousands or even maybe more. This scenario is so overstretched and made to sound so simplistic that it could no longer be deemed as realistic. Sure, maybe most of the people confronted with this largely unrealistic situation mentioned above would give in; after all, it is a no brainer right? Torture one, save thousands, even more. Things are not like that though and other factors need to be taken into consideration when debating on whether or not torture should be allowed at least in these extreme situations. In this situation the overlooked factors are of decisive importance. Pro torture theorists’ make two very big mistakes (on purpose of course to mislead people); they transform this scenario into a general rule, a regular occurrence with which most of the people will be confronted at some point in their livelihood, instead of the exception it actually is. There has only been one case recorded where the Philippine authorities have tortured a terrorist for sixty-seven days in order to get information ou t of him that may have stopped an attempt to assassinate the pope and crash eleven planes into the Pacific Ocean. The planes had approximately four thousand passengers. The first problem is that this extreme act of terrorism is an exceptional occurrence and by no means a regular one, and leads us to the second huge flaw of this ‘ticking bomb scenario’, the fact that it is riddled with uncertainty. The Philippine authorities have tortured the man for such a long a time that they were themselves amazed that he was still alive when he gave them the information; so they tortured him without even being sure that he knows anything, without being sure that he would survive to give them any information at all and without actually being sure that the information he would maybe provide would indeed prove to be useful. How can it therefore ever be right even in this scenario to torture someone? It is close to impossible to ever be sure that a person actually has any useful information; it is also never a certain thing that even if he provides some information that information is true. No one s hould ever be humiliated and treated in such a way as a tortured person is since nothing can ever be one hundred per cent certain when it comes to torture because a person in the pains of torture would say anything to put an end to the pain. What if the tortured person actually does not know anything about a plot? What then? The torturer will never stop since he has to get the information out therefore he tortures with the certainty that the tortured has the information while he might actually know nothing. Should in this situation the torturer be allowed to torture the wife, children and other relatives in order to get the information out? Where would this entire process stop? After all he might know something; even if after he has been tortured and watched his wife be tortured and killed in front of him he still says no, the torturer is still sure that he is withholding information so he continues with his children. If he still does not say anything the torturer might think that he is a very well trained terrorist and very loyal to his cause, so why stop? The torturer can be just as determined and loyal to his cause in return and continue to torture as many relatives of the victim as he possibly can to get the informat ion out of him. This is a built-in problem of the whole ‘ticking bomb scenario’, a problem because the terrorist might know something that if he might disclose to the torturer, might prove as valuable information. Not only does the ‘ticking bomb scenario’ almost never arise, but even in the extreme eventuality that it does, getting the information, and not just any information but the right one seems as probable as finding a needle in a haystack while being blindfolded and wearing boxing gloves; and yet some people are still not convinced and would, even in these given situations, employ the degrading and inhumane act of torture. If so, why not make even make it a fun thing to try and alleviate the gravity of such a situation and allow people to bet on whether or not the victim will give out the right information and foil the plot; a person would easily be offered really good odds and be able to win fortunes with a mere penny. Furthermore, again in the area of how everything related to torture is uncertain and holds no guarantee we must acknowledge that even if after all those presented above, we succumb to the use of torture, we allow for it to happen, we get the information which eventually proves to be right and stops a bombing, the terrorists could just as well plan another bombing, or maybe even more to revenge their tortured friend? As far as I am concerned under no circumstances should torture ever be used? Not only should it always be illegal but no matter how pro-torture theorists try to sugar coat it, it will always be immoral. It degrades everyone involved in it, as well as the entire society, it makes everyone a part of an inhumane act that can never guarantee anything. It should not happen ‘under the radar’ because it would mean that the elected officials that allow it to take place renounce their democratic beliefs and abandon their morals. It should not happen with the approval of the people because then everyone renounces their democratic ideologies and morals; the entire society would become more violent which is not something to overlook even if it raises by a very small degree; an entire torture related authority and mentality would be born that would only sadden and inherently take its toll on everyone`s daily livelihood. As we have seen there are no possible situations that might warrant a use of torture since in all given scenarios the trade-off in the long run would always prove to be a very bad one. Humanity should never trade its morals, its principles and its liberal and democratic values for the smallest odds of saving one, ten, or one million lives. The best way to express this is by thinking about the situation in which the Prime Minister of Italy, Aldo Moro, was kidnapped and when someone suggested the use of torture to find out where he is being held, General Carlo Alberto Dalla Chiesa replied: â€Å"Italy can survive the loss of Aldo Moro. It would not survive the introduction of torture.† It is not only Italy that could not survive the introduction of torture, but the entire civilized world. For all the arguments employed above against the use of torture in any kind of scenario, even in the strictly utilitarian one where torture should be used as long as the number of people saved is higher than the number of people tortured and killed, we can draw the humane and moral conclusion that torture should always be unlawful and immoral and therefore an absolute right against torture is warranted.

Friday, January 10, 2020

Wgu Nut1

Introduction to the Electronic Medical Record (EMR) Introduction to the Electronic Medical Record (EMR) Gary L Williams Western Governors University Introduction to the Electronic Medical Record (EMR) The new millennium has produced many changes in the world as we know it. Our national security which seemed to be impermeable has revealed its vulnerability to being breached. Remember September 11, 2001 when the hi-jacking of planes lead to the destruction of the Twin Towers in New York City, and severe damage the Pentagon in Washington DC.Now our Healthcare System has now moved into the information highway. How you may ask, through the introduction of the EMR. So will the EMR be safe and secure? Let us investigate. So just what is the EMR? There are many formal definitions but the one that stands out and will be used today is from the Healthcare Information and Management Systems Society (HIMSS). It states: The Electronic Health Record (EHR) is a longitudinal electronic record of pati ent health information generated by one or more encounters in any care delivery setting.Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly via interface – including evidence-based decision support, quality management, and outcomes reporting. (HIMSS) Within this definition there is a multitude of system components.Think of it like the multiple Introduction to the Electronic Medical Record (EMR) dividers that were found in the paper medical record. For instance, you may see headers like, medication record, order entry, nursing assessments, the plan of care, education, radiology, cardiology, etc. Under the medication tab la ys the eMAR, medication history, and reconciliation. Each band with the click of the mouse will open a new file within this record. The design is formatted to follow a systematic flow with check boxes, drop down lists, or free text space to document the patient findings, activities, and assessments.The EMR will have many benefits for the entire healthcare team and the patient. By development and design with the assistance of key personnel, the EMR should flow and make documentation easier. By having a standardized flow and options to document the standards of care, documenting should become easier and provide more consistency. Take for example a urine description. You may see for color description amber, yellow, red, clear, or tea. Then cloudy, turbid, clots, or mucous followed by malodorous, sweet, or pungent. This will provide a means of potential measurement for Evidence-Based Medicine (EBM).How many patients with UTI receiving Bactrim DS have amber mucous pungent urine on a GU u nit? Can you see the pattern? The EMR will assist in critical thinking as well. Your physical assessment for instance may be by body system or a complete head to toe assessment. These screens will assist the nurse in reminders of required documentation. The nurse may receive a task list for a certain procedure or required documentation of a high risk factor, such as fall precautions, to alert the bedside nurse or technician that the document is due or past due.Introduction to the Electronic Medical Record (EMR) The EMR will provide real time data and reports from various disciplines within the healthcare facility. For instance, a Vancomycin trough was ordered at 0700 and its 0900 and the IV medication is due. By selecting the laboratory tab your result will be there in front of you before the dose is administered. The same can be expected of radiology imagining results, EKG, stress test reports, a bedside capillary glucose test done by the technician. No more searching through multi ple computer systems or piles of lab results to find the data you need.The information is there and readily available. Healthcare providers have the penmanship of a deranged mad scientist. How often do you have multiple nurses trying to determine what Dr. Hyde just wrote? What if you guess wrong? Now you place that call to Dr. Hyde for clarification when you have a multitude of things to be doing. With Computerized Provider Order Entry (CPOE), no longer will guessing what was written be an issue. Standard order sets will be available with the opportunity to be individualized or modified from a pre-determined list of ommon orders for routine admission or for specific disease processes like the Acute Myocardial Infarction. Included may be diet, activity, vital signs, IV fluids, labs, EKG, PCXR, or consults. As touched upon earlier with the urine sample report, there is a myriad of potential data that can be extrapolated to form reports for research and to assist with the EBM. What is the average number of days for patients on the ventilator for June, 2011? How many patients in the rehabilitation unit have pressure ulcers? Maybe a nurse says to the unit manager that it seems like a large number of the patients on the unit have C- Difficile?A report can be run to show Introduction to the Electronic Medical Record (EMR) trends of the patients with this condition. Maybe it’s a hand washing issue or cross contamination from multi-use bathroom facilities. There are many opportunities that would at best have been difficult to track from the old paper medical record. Identity theft is rampant in this world of technology. How will the EMR be secured? How can the nurse access the EMR? Today home computers are almost essential. The same virus and malware that affect your home computer can infect the EMR if security is lacking.The Information Technology team will provide the overall security for the system by continuous upgrades to software like antivirus and firewal l protection. Each team member will be issued a unique log-in and password to access the EMR. This must be kept strictly confidential for the nurse’s protection. This secure log-in is like a finger print of the assigned user. When the EMR is accessed, there is a time stamp of what records were accessed, for what length of time, and by whom. A secure trail of entry into the EMR can be traced. What is the Personal Health Record (PHR) and how does it differ from the EMR?The PHR is essentially the same document that you would produce in the Physician’s Office. The PHR can be completed online either through a Physician’s Office or through an outside resource. Things that would be included in the PHR might be your name, address, telephone number, date of birth, and possibly the social security number. This record could also contain your Physicians name and phone number, the list of your current medications and dosages, a list of current and Introduction to the Electro nic Medical Record (EMR) past medical conditions, and passed surgical history.This type of a record is usually maintained by the patient themselves. The PHR will differ from the Electronic Medical Record in that the Electronic Medical Record is property of the Health Care facility and not the consumer. The personal health record becomes more vulnerable to breaches in security since it is maintained by the consumer. For example, I might give my sign on and password to my family or friend to input data for me. This obviously breaches ones security. This allows access to these individuals to alter ones personal health record at will.The website that maintains the personal health record may not be as secure as that of the Health Care facility. The Electronic Medical record is usually maintained by the healthcare facility, outpatient clinic, or Physician’s Office. These healthcare facilities must maintain high security to protect the information within that medical record. In 1996 , Congress passed a law entitled The Health Insurance Portability & Accountability Act (HIPAA). This law was designed: -To improve portability and continuity of health insurance coverage in the group and individual markets. To combat waste, fraud, and abuse in health insurance and health care delivery. -To reduce costs and the administrative burdens of health care by improving efficiency and effectiveness of the health care system by standardizing the interchange of Introduction to the Electronic Medical Record (EMR) electronic data for specified administrative and financial transactions. -To ensure protecting the privacy of Americans’ personal health records by protecting the security and confidentiality of health care information. (James) The security and confidentiality are paramount. Fines are levied as a result of a breech to the HPPA law.There must be alerts to vulnerabilities, safeguards to help protect the EMR and the Information Technology team must be able to identi fy possible threats. Using an EMR (electronic medical record) has no absolute right and wrongs in either computer equipment or software for HIPAA compliance. Usually there are four areas to examine: -Physical Security – can your computers with patient data be stolen? -User Security – can anybody log on to the patient database? -System Security – what happens on a hard drive crash? -Network Security – can unauthorized persons outside your facility access patient data? Milne, 2006) Security is never easy to maintain; it requires continuous safeguarding. As a team we are all responsible to assist in the security of the EMR. Always log on and off when you are no longer Introduction to the Electronic Medical Record (EMR) using the bedside computer. Always check before charting that it is indeed you that is longed into the system and that only one patient record at a time is open for use. The EMR can be a valuable tool for Quality Improvement (QI). Through the design phase, a number of measurable data can be built into the EMR for report generation.If the team wanted to look at the number of times vital signs were not documented as dictated per Policy & Procedure. This data can be built into the system and reports run daily, weekly, or monthly. The same thing can be built to monitor for overdue or omitted medications. This can be further expanded to identify which team member is involved and to check for trends. Data may also be collected to support EBM. For example, tracking the effectiveness of two different antibiotic treatment regimens of a selected disease process may be used to support a change in the disease treatment (e. . antibiotic A showed improvement in five days where as antibiotic B showed improvement in ten days. ) Here again the possibilities seem endless. Think of the time savings for all the key people that would be required to look through endless paper medical records for this type of data collection in the paper medic al record. So how does the EMR come to fruition? It takes a large team of various specialties and specialists to develop the EMR. It starts with the Healthcare system researching and then purchasing the best system to fit the company’s needs and requirements.Once purchased, the owner of the software will deploy a team of specialists that will assist the Healthcare systems team to design and develop the contents and flow of the EMR. The team includes senior management which will assist in the purchase and be the governing authority of the proposed Introduction to the Electronic Medical Record (EMR) work flow before implementation. There are many subdivided teams. Nursing will have Subject Material Experts (SME) that will be the voice to assist in the flow, wordage, and design of the nursing components of the EMR. The SME’s will be from every department of nursing.From this group will be the Super User. The Super User will act as the cheerleader for the project developme nt and will be the main source for assisting with the Go Live of the EMR. The Information Technology (IT) will be a multi-tiered group ranging from System Support Analyst or the front line of communication, the Computer Programmers and System Analyst or the builders and troubleshooters, to the Project Managers or the supervisors of the IT team. Nursing will also have the Clinical Informatics Application Analyst who will be the voice between nursing and the technical side of issues, concerns, and development.The End User which is the front lines of nursing and everyone that will be using the system for documentation. And last but not least will be the Educators that will teach the system to the entire team. This is a rather large of individuals working as the voice of the EMR development and implementation. In conclusion, change will be rough at times but change is necessary for progression. Be positive and listen to the teams and the tips that are offered. Assist each other as suppo rt with the continued learning and development of the EMR. The Technology age is here and we should all reap the benefits of this endeavor.Remember how Florence Nightingale was the frontier to nursing as we know it. Well each of you deserves a pat on the back as you are the pioneers that have lead nursing into the technology phase of the Electronic Medical Record. You too are a part of nursing history. References HIMSS. (n. d. ) EHR Electronic Health Record. Retrieved from http://www. himss. org/asp/topics_ehr. asp James, R. (n. d. ) What is HIPPA? Retrieved from http://www. dhmh. state. md. us/hipaa/whatishipaa. html Milne, M. (2006, March 6). HIPAA in a â€Å"Nutshell† – Guidelines for EMR and Paper Medical Records Compliance.Retrieved from http://ezinearticles. com/? HIPAA-in-a-Nutshell—Guidelines-for-EMR-and-Paper- Medical-Records-Compliance&id=156737 Ten open ended questions. 1. When the EMR is first implemented on your unit, how can you assure the patient that you are competent in your profession? You will explain that you are a seasoned nurse and an expert in the nursing field. Today our facility is introducing the new EMR which will benefit you in the future. This will take a little more time for me to learn and I do not want you to feel like you are being ignored. I may have to ask you a lot of questions as I go through each section.Please feel free to ask me any questions or concerns that you may have. Our goal is your comfort and safety though the high quality of care. 2. On the day of Go-Live, how can your unit best assist you in providing support as you learn this new technology? My unit manager should over staff initially as we learn the new system. I can foresee the nurse being so buried in the computer that the delivery of care might be too slow initially. Having the extra staff will decrease the patient load and allow extra hands to assist with the delivery of care. 3. As you learn the new system there will be some anticip ated frustration.How can you divert this frustration so that your patient doesn’t sense that something is wrong? We will need to have the Super-User and Analyst available to assist us as problems or concerns occur. It is imperative that the bed side nurse remain positive an up beat as we learn. I suggest maybe huddles through out the day away from the bed side to discuss our concerns. We don’t want the patient to feel uncomfortable. 4. Your patient asks you why it is important to have the computer charting. Briefly tell me what you might say and why? The EMR is being implemented throughout the area as well as world wide.As you record develops, we will only need to verify some of your past medical history, allergies, medications, etc. These types of data will flow from one visit to another making you care easier as the data is readily available. No more waiting for old charts to arrive and thumbing through page after page of data to look for pertinent information. 5. Ho w do you perceive future benefits of an interoperable EMR? It will be possible in the future as the EMR progresses, that your hospital record, physician office record, out patient records, and pharmacy to communicate with each other.By doing so, some potential errors may be thwarted. For instance, maybe you are not able to recall all of your home medications and your consulting physician decides you need a new blood pressure medication. If the records could speak to each other then this physician would be able to see that you were already prescribed an antihypertensive medication or the pharmacy might catch the possible error. 6. Futuristically, let’s say you take a dream vacation to a foreign country. While on your visit you become ill and collapse unconsciously.How can the interoperable EMR potentially be a benefit in this case? If the system develops into a world wide communication link, then with limited data perhaps the hospital in the foreign country would be able to ac cess and utilize my EMR to provide answers in how to deliver the best possible care for me. So if I went in with a suspected ruptured appendix, by accessing my EMR surgical history it would be noted that I have had an appendectomy ten years prior so the focus could be directed at another possible cause. 7.Your patient states to you that she hates the computer and that it is the devils advocate. She is tearful and appears anxious. How might you handle this as you are in the middle of documenting in the EMR? You should stop what you are doing and maybe sit beside the patient and gently hold her hand and ask what seems to be troubling her? She might say she feels the nurses spend more time touching the computer and no time touching her, as you just did, and that we come across as cold and not caring. We need to realize that patient interaction is still paramount to the overall delivery of care.Take time to interact with the patient. Then step back and document; perhaps explaining what you are documenting and why it is important to her care. 8. What do you anticipate will be your plan of action when the computer system is down? What will be your back up plan? If the computer is down for a set amount of time, as determined by the hospitals administration, then the paper chart will be utilized. If the downtime is for an extended period of time, then this data would be scanned into the EMR as soon as possible after the computer system is back on line.If the duration was short, say an hour or so, then this data should be manually documented back into the EMR with the assessment time documented. 9. How do you anticipate computer physician order entry being a benefit? For one legibility! No more trying to decode what you think may have been written. It will be clear and concise. Also the physician may be able to look at documentation form somewhere other than the patients unit and decide orders need to be given. He can simply do computer order entry and a task will appe ar for new orders.If the order is anything other than routine, a call should be placed to alert the nurse of the priority. 10. What do see as a benefit to Quality Improvement by the institution of the EMR on a unit basis? We will be able to track data at a faster and higher accuracy a opposed to thumbing through paper record after record searching for data collection. The data collected can be as concise as to a particular nurse or a specific health issue. The data collected helps to support EBM change.

Thursday, January 2, 2020

Tony Fernandes - 2128 Words

Contents Biography ...†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦ 2 Death †¦Ã¢â‚¬ ¦...†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦ 4 Humanistic Theories of Self-Actualization ...†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...†¦ 4 Hierarchy of Needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... 6 1. Physiological needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 2. Safety needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 3. Belongingness and Love needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 4. Esteem needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 5. Self-actualization †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 The Advantages and Disadvantages of Maslow’s Hierarchy of Needs †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... 9 Criticism to the Theory †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 Recommendations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 11†¦show more content†¦These two were so accomplished in both realms and such wonderful human beings as well, that Maslow began taking notes about them and their behaviour. This would be the basis of his lifelong research and thinking about mental health and human potential. He wrote extensively on the subject, borrowing ideas from other psychologists but adding significantly to them, especially the concepts of a hierarchy of needs, metaneeds, metamotivation, self-actualizing persons and peak experiences. After a near-fatal heart attack in 1967, Maslow believes that the rest of his life would be short. He saw himself as a psychological pioneer; widely explore new areas of human experience that investigators would show in detail later. Seeing the exact contours of his turbulent intellectual life, we are better equipped for the cards that our world needs today to create to achieve our individual and social potential. Death Maslow was a professor at Brandeis University from 1951 to 1969, and then became a fellow resident of the Laughlin Institute in California. He died of a heart attack on June 8, 1970. Humanistic Theories of Self-Actualization Maslow was already a 33 years old father and had children by the advent of World War II in 1941. He was thus eligible for the military. However, the horrors of war inspired a vision of peace in him instead and led to his groundbreakingShow MoreRelatedTony Fernandes2905 Words   |  12 Pages1.0 INTRODUCTION Nowadays, AirAsia is the best of the Asian airline companies in its market segment and became profitable almost immediately after Tony Fernandes took it over in spite of the air-travel downturn following the 11 September 2001 terrorist attacks. These results can be only explained by the fact that Tony Fernandes is a great leader. First of all, his skills and personal qualities are those of a good leader. He was entirely committed to his business (sometimes with a little humor)Read MoreTony Fernandes4756 Words   |  20 PagesIntroduction Tan Sri Anthony Franicis Fernandes or knows as Tony Fernandes is a Malaysian entrepreneur in airline business. 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The later developed new routes in the following years were included SingaporeRead MoreAir Asia Structure1698 Words   |  7 Pagesindustry started based on the low cost carrier (LCC) concept in Malaysia. The low cost concept is introduced in the year of 2001 with the belief that â€Å"Now Everyone Can Fly† by Tony Fernandes. AirAsia was first established in 1993 and began its operation on 18 November 1996. In the year 2001, Anthony Fernandes (or known as Tony Fernandes) bought the airlin e which is suffering a loss. It was re-established as the low cost carrier after the bought over. AirAsia’s vision is to be the largest low cost airline